ORCHESTRA Delphi consensus: diagnostic and therapeutic management of SARS-CoV-2 infection in patients with rheumatological diseases

Abstract

Objectives: The clinical management of COVID-19 in immunocompromised patients remains a challenge. This work aimed to develop a consensus to establish recommendations for the clinical, diagnostic, and therapeutic management of patients with rheumatic diseases and COVID-19.

Methods: A panel of 14 international experts was selected, and Delphi methodology was used for the consensus, after a systematic literature review. Twenty-four questions were formulated and presented to the panel. The experts voted using a 6-point Likert scale (1) 'Strongly disagree' (SD); (2) 'Disagree' (D); (3) 'Somewhat disagree' (SWD); (4) 'Somewhat agree' (SWA); (5) 'Agree' (A); (6) 'Strongly agree' (SA). To establish consensus, simple or cumulative agreement ≥80% was required over a maximum of three rounds. Cumulative agreement was defined as the sum of response percentages on items 1-2 (SD + D); 2-3 (D + SWD); 4-5 (SWA + A); or 5-6 (A + SA), distinguishing a strong degree of agreement (A + SA) or disagreement (SD + D) from a moderate degree of agreement (SWA + A) or disagreement (D + SWD).

Results: After the three rounds, consensus was reached on 23 of the 24 questions and 10 recommendations were made.

Discussion: The Delphi methodology allowed consensus on recommendations in areas with insufficient scientific evidence, which can be considered for decision-making in the management of patients with rheumatological diseases while awaiting better evidence.

Keywords: COVID-19; Delphi; Immunosuppression; Rheumatological diseases; SARS-CoV-2.