A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease

Manjit K. Cartlidge; Kevin K. Brown; Nazia Chaudhuri; Tamera J. Corte; Phillipe Dieudé; Levin John; Clive Kelly; Dinesh Khanna; Euan McRorie; Lisa Nicol; Gareth Stewart; Simon L. F. Walsh; Marlies Wijsenbeek; Nik Hirani; PASSWRD participants

doi:10.1186/s12890-024-03287-0

A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease

Manjit K. Cartlidge^*
, Kevin K. Brown
, Nazia Chaudhuri
, Tamera J. Corte
, Phillipe Dieudé
, Levin John
, Clive Kelly
, Dinesh Khanna
, Euan McRorie
, Lisa Nicol
, Gareth Stewart
, Simon L. F. Walsh
, Marlies Wijsenbeek
, Nik Hirani
, PASSWRD participants

^*Corresponding author for this work

University of Edinburgh
National Jewish Health
Ulster University
The University of Sydney
Université Paris Cité
Yenepoya University
South Tees Hospitals NHS Foundation Trust
University of Michigan, Ann Arbor
Western General Hospital
Imperial College London
Erasmus University Rotterdam

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Drugs used to treat rheumatic disease are associated with pneumotoxicity (drug-induced lung disease), but little is known about associated risk factors. Aim: To determine expert physician-perceived risk factors for developing pneumotoxicity in patients with rheumatologic conditions. Methods: A modified international 3-tier Delphi exercise was performed. Tier 1 determined patient and drug variables that physicians perceive to be risk factors. Tier 2 determined degree of risk associated with the Tier-1 derived variables. Tier 3 aimed to internally validate and stratify exemplar cases into risk categories. Results: 134 pulmonologists and 49 rheumatologists responded to Tier 1;157 physicians completed all tiers. Perceived risk factors included: drug type; history of previous pneumotoxicity; age; smoking; underlying rheumatic disease type and activity; renal function; pulmonary hypertension; left ventricular failure;presence, nature, severity and progression of pre-existing interstitial lung disease. Tier 2 data stratified these variables into risk profiles e.g. never versus current smoking was perceived as low and high risk respectively. An example of perceived high risk resulting from Tier 3 is a 75-year-old current smoker with high-activity rheumatoid arthritis (RA) with severe, progressive ILD being started on methotrexate. A perceived low risk is a 75-year-old currentsmoker with moderate-activity RA and emphysema with no cardiac or renal disease and no pre-existing ILD being started on rituximab. A risk prediction scoring tool is being developed to be used in validation studies. Conclusion: This modified Delphi exercise defined and stratified the perceived risk factors for developing pneumotoxicity. Age, current smoking, high underlying rheumatological disease activity, HRCT definite UIP and honeycombing, severity and progression of pre-existing ILD were perceived to be the highest risk-factors.

Original language	English
Article number	547
Journal	BMC pulmonary medicine
Volume	24
Issue number	1
DOIs	https://doi.org/10.1186/s12890-024-03287-0
Publication status	Published - 1 Dec 2024

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Drug-induced interstitial lung disease
Drug-induced pneumotoxicity
Interstitial lung disease
Pneumotoxicity
Rheumatological drugs

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Cartlidge, M. K., Brown, K. K., Chaudhuri, N., Corte, T. J., Dieudé, P., John, L., Kelly, C., Khanna, D., McRorie, E., Nicol, L., Stewart, G., Walsh, S. L. F., Wijsenbeek, M., Hirani, N., & PASSWRD participants (2024). A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease. BMC pulmonary medicine, 24(1), Article 547. https://doi.org/10.1186/s12890-024-03287-0

@article{8396b1272aad430a91b2cb38acde20e1,

title = "A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease",

abstract = "Background: Drugs used to treat rheumatic disease are associated with pneumotoxicity (drug-induced lung disease), but little is known about associated risk factors. Aim: To determine expert physician-perceived risk factors for developing pneumotoxicity in patients with rheumatologic conditions. Methods: A modified international 3-tier Delphi exercise was performed. Tier 1 determined patient and drug variables that physicians perceive to be risk factors. Tier 2 determined degree of risk associated with the Tier-1 derived variables. Tier 3 aimed to internally validate and stratify exemplar cases into risk categories. Results: 134 pulmonologists and 49 rheumatologists responded to Tier 1;157 physicians completed all tiers. Perceived risk factors included: drug type; history of previous pneumotoxicity; age; smoking; underlying rheumatic disease type and activity; renal function; pulmonary hypertension; left ventricular failure;presence, nature, severity and progression of pre-existing interstitial lung disease. Tier 2 data stratified these variables into risk profiles e.g. never versus current smoking was perceived as low and high risk respectively. An example of perceived high risk resulting from Tier 3 is a 75-year-old current smoker with high-activity rheumatoid arthritis (RA) with severe, progressive ILD being started on methotrexate. A perceived low risk is a 75-year-old currentsmoker with moderate-activity RA and emphysema with no cardiac or renal disease and no pre-existing ILD being started on rituximab. A risk prediction scoring tool is being developed to be used in validation studies. Conclusion: This modified Delphi exercise defined and stratified the perceived risk factors for developing pneumotoxicity. Age, current smoking, high underlying rheumatological disease activity, HRCT definite UIP and honeycombing, severity and progression of pre-existing ILD were perceived to be the highest risk-factors.",

keywords = "Drug-induced interstitial lung disease, Drug-induced pneumotoxicity, Interstitial lung disease, Pneumotoxicity, Rheumatological drugs",

author = "Cartlidge, \{Manjit K.\} and Brown, \{Kevin K.\} and Nazia Chaudhuri and Corte, \{Tamera J.\} and Phillipe Dieud{\'e} and Levin John and Clive Kelly and Dinesh Khanna and Euan McRorie and Lisa Nicol and Gareth Stewart and Walsh, \{Simon L. F.\} and Marlies Wijsenbeek and Nik Hirani and \{PASSWRD participants\} and Hilario Nunes and Deborah Assaya and Sameep Sehga and Stebbings, \{Simon M.\} and Alejandro Robles-Perez and Anjali Crawshaw and Gunnar Gudmundsson and Blum, \{H. C.\} and Bruno Crestani and Paola Confalonieri and Marco Sebastiani and Armando Gabrielli and Elisabetta Balestro and Esen Kiyan and Jadranka Morovic-Vergles and Virginia Berlengiero and Pilar Rivera-Ortega and Toshiaki Matsuda and Vera Bernardino and Peter Saunders and Marovic, \{Kristina Frketic\} and Alberto Sulli and \{van der Lee\}, Ivo and Andreina Manfredi and Abdulla Al-farttoosi and Corrado Campochiaro and Nossent, \{E. J.\} and Michele Iudici and Ryerson, \{Christopher J.\} and Silvia Grazzini and Emma Derrett-Smith and Helen Parfrey and Venero MdC and Yuko Waseda and \{Reza Beiga\}, \{Davide Mohammed\} and Elvis Hysa and Toma, \{Claudia Lucia\} and Alain Delobbe and Spencer, \{Lisa G.\} and Godoy and Su-Ying Low and Nesrin Mogulkoc and Yasemin Kabasakal and Dijana Perkovic and Ross, \{Alessandra Della\} and Kalyoncu, \{Ali Fuat\} and Solomon, \{Joshua J.\} and Liudmila Garzanova and Simona Rednic and Busaid, \{Nasser Al\} and Shital Patil and Pierre-Antoine Juge and Rosario Foti and Edoardo Rosato and Sergio Campainha and Jones, \{Richard Mathew\} and Claudia Cobilinschi and Martin Kolb and Gheorghiu, \{Ana Maria\} and Highland, \{Kristin B.\} and Tracy Luckhardt and Keisuke Tomii and Shigeki Saiton and Alfredo Guillen and Angela Ceribelli and Aditya Agrawal and Raphael Borie and Stewart, \{Gareth A.\} and Rebecca Grainger and Danielle Antin-Ozerkis and Ramirez, \{Maria Teresa Rio\} and Jens Vikse and Fotio Drakopanagiotakis and Lipchik, \{Randolph J.\} and Diego Castillo and \{Garcia Martos\}, {\'A}lvaro and Nicol, \{Lisa M.\} and Gardiner, \{Philip V.\} and Semra Bilaceroglu and Philippe Camus and Johannson, \{Kerri A.\} and O{\textquoteright}Beirne, \{Sarah L.\} and Judge, \{Eoin P.\} and Carty, \{Sara Madelaine\} and Montoya, \{Sandra Fabiana\} and \{Garcia Gonzalez\}, Estrella and Felix Chua and Walker, \{Ulrich A.\} and Caterina Naclerio and Devi, \{H. J. Gayathri\} and Castro, \{Horacio Matias\} and Culver, \{Dr Emma L.\} and David Launay and Davidsen, \{Jesper R. mhild\} and Myall, \{Katherine J.\} and Maurizio Benucci and Maher, \{Toby M.\} and El{\.z}bieta Radzikowska and Simone Scarlata and Chai, \{Gin Tsen\} and Nunes, \{Mario Sergio\} and Mauricio Salinas and Glenn Eiger and Amaral, \{Alexandre Franco\} and Koduri, \{Gouri M.\} and Marko Baresic and Turner, \{Alice M.\} and \{Hajari Case\}, Amy and Meena Kalluri and Shinyu Izumi and V. Keshavan and Edoardo Conticini and \{Brito de Araujo\}, Daniel and Michael Perch and Jones, \{Mark G.\} and Vanesa Vicens-Zygmunt and Alexandra Balbir-Gurman and Harvard Fretheim and Yoshinori Tanino and Papanikolaou, \{Ilias C.\} and Marta Dzhus and Sergey Avdeev and Carolina Muller and Padilla, \{Maria L.\} and Adrian Shifren and Wilsher, \{Margaret L.\} and Ahmed Fahim and Patel, \{Divya C.\} and Luca Novelli and David Bennett and Wuyts, \{Wim A.\} and Paolo Cameli and Dhasmana, \{Devesh J.\} and Carreira, \{Patricia E.\} and Tiago Alfaro and \{Kah-Lai Leong\}, Carrie and Suranjan Mukherjee and Pedro Ferreira and Tonya Russell and Enrico Selvi and Nazia Chaudhury and Albert Selva-O{\textquoteright}Callaghan and Carbone, \{Roberto G.\} and Elisabeth Bendstrup and \{L{\'o}pez Miguel\}, Patricia and Benjamin Chaigne and Charlotte Hyldgaard and Janardhana Golla and Chalmers, \{George W.\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = dec,

day = "1",

doi = "10.1186/s12890-024-03287-0",

language = "English",

volume = "24",

journal = "BMC pulmonary medicine",

issn = "1471-2466",

publisher = "BioMed Central Ltd.",

number = "1",

}

Cartlidge, MK, Brown, KK, Chaudhuri, N, Corte, TJ, Dieudé, P, John, L, Kelly, C, Khanna, D, McRorie, E, Nicol, L, Stewart, G, Walsh, SLF, Wijsenbeek, M, Hirani, N & PASSWRD participants 2024, 'A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease', BMC pulmonary medicine, vol. 24, no. 1, 547. https://doi.org/10.1186/s12890-024-03287-0

TY - JOUR

T1 - A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease

AU - Cartlidge, Manjit K.

AU - Brown, Kevin K.

AU - Chaudhuri, Nazia

AU - Corte, Tamera J.

AU - Dieudé, Phillipe

AU - John, Levin

AU - Kelly, Clive

AU - Khanna, Dinesh

AU - McRorie, Euan

AU - Nicol, Lisa

AU - Stewart, Gareth

AU - Walsh, Simon L. F.

AU - Wijsenbeek, Marlies

AU - Hirani, Nik

AU - PASSWRD participants

AU - Nunes, Hilario

AU - Assaya, Deborah

AU - Sehga, Sameep

AU - Stebbings, Simon M.

AU - Robles-Perez, Alejandro

AU - Crawshaw, Anjali

AU - Gudmundsson, Gunnar

AU - Blum, H. C.

AU - Crestani, Bruno

AU - Confalonieri, Paola

AU - Sebastiani, Marco

AU - Gabrielli, Armando

AU - Balestro, Elisabetta

AU - Kiyan, Esen

AU - Morovic-Vergles, Jadranka

AU - Berlengiero, Virginia

AU - Rivera-Ortega, Pilar

AU - Matsuda, Toshiaki

AU - Bernardino, Vera

AU - Saunders, Peter

AU - Marovic, Kristina Frketic

AU - Sulli, Alberto

AU - van der Lee, Ivo

AU - Manfredi, Andreina

AU - Al-farttoosi, Abdulla

AU - Campochiaro, Corrado

AU - Nossent, E. J.

AU - Iudici, Michele

AU - Ryerson, Christopher J.

AU - Grazzini, Silvia

AU - Derrett-Smith, Emma

AU - Parfrey, Helen

AU - MdC, Venero

AU - Waseda, Yuko

AU - Reza Beiga, Davide Mohammed

AU - Hysa, Elvis

AU - Toma, Claudia Lucia

AU - Delobbe, Alain

AU - Spencer, Lisa G.

AU - Godoy, null

AU - Low, Su-Ying

AU - Mogulkoc, Nesrin

AU - Kabasakal, Yasemin

AU - Perkovic, Dijana

AU - Ross, Alessandra Della

AU - Kalyoncu, Ali Fuat

AU - Solomon, Joshua J.

AU - Garzanova, Liudmila

AU - Rednic, Simona

AU - Busaid, Nasser Al

AU - Patil, Shital

AU - Juge, Pierre-Antoine

AU - Foti, Rosario

AU - Rosato, Edoardo

AU - Campainha, Sergio

AU - Jones, Richard Mathew

AU - Cobilinschi, Claudia

AU - Kolb, Martin

AU - Gheorghiu, Ana Maria

AU - Highland, Kristin B.

AU - Luckhardt, Tracy

AU - Tomii, Keisuke

AU - Saiton, Shigeki

AU - Guillen, Alfredo

AU - Ceribelli, Angela

AU - Agrawal, Aditya

AU - Borie, Raphael

AU - Stewart, Gareth A.

AU - Grainger, Rebecca

AU - Antin-Ozerkis, Danielle

AU - Ramirez, Maria Teresa Rio

AU - Vikse, Jens

AU - Drakopanagiotakis, Fotio

AU - Lipchik, Randolph J.

AU - Castillo, Diego

AU - Garcia Martos, Álvaro

AU - Nicol, Lisa M.

AU - Gardiner, Philip V.

AU - Bilaceroglu, Semra

AU - Camus, Philippe

AU - Johannson, Kerri A.

AU - O’Beirne, Sarah L.

AU - Judge, Eoin P.

AU - Carty, Sara Madelaine

AU - Montoya, Sandra Fabiana

AU - Garcia Gonzalez, Estrella

AU - Chua, Felix

AU - Walker, Ulrich A.

AU - Naclerio, Caterina

AU - Devi, H. J. Gayathri

AU - Castro, Horacio Matias

AU - Culver, Dr Emma L.

AU - Launay, David

AU - Davidsen, Jesper R. mhild

AU - Myall, Katherine J.

AU - Benucci, Maurizio

AU - Maher, Toby M.

AU - Radzikowska, Elżbieta

AU - Scarlata, Simone

AU - Chai, Gin Tsen

AU - Nunes, Mario Sergio

AU - Salinas, Mauricio

AU - Eiger, Glenn

AU - Amaral, Alexandre Franco

AU - Koduri, Gouri M.

AU - Baresic, Marko

AU - Turner, Alice M.

AU - Hajari Case, Amy

AU - Kalluri, Meena

AU - Izumi, Shinyu

AU - Keshavan, V.

AU - Conticini, Edoardo

AU - Brito de Araujo, Daniel

AU - Perch, Michael

AU - Jones, Mark G.

AU - Vicens-Zygmunt, Vanesa

AU - Balbir-Gurman, Alexandra

AU - Fretheim, Harvard

AU - Tanino, Yoshinori

AU - Papanikolaou, Ilias C.

AU - Dzhus, Marta

AU - Avdeev, Sergey

AU - Muller, Carolina

AU - Padilla, Maria L.

AU - Shifren, Adrian

AU - Wilsher, Margaret L.

AU - Fahim, Ahmed

AU - Patel, Divya C.

AU - Novelli, Luca

AU - Bennett, David

AU - Wuyts, Wim A.

AU - Cameli, Paolo

AU - Dhasmana, Devesh J.

AU - Carreira, Patricia E.

AU - Alfaro, Tiago

AU - Kah-Lai Leong, Carrie

AU - Mukherjee, Suranjan

AU - Ferreira, Pedro

AU - Russell, Tonya

AU - Selvi, Enrico

AU - Chaudhury, Nazia

AU - Selva-O’Callaghan, Albert

AU - Carbone, Roberto G.

AU - Bendstrup, Elisabeth

AU - López Miguel, Patricia

AU - Chaigne, Benjamin

AU - Hyldgaard, Charlotte

AU - Golla, Janardhana

AU - Chalmers, George W.

PY - 2024/12/1

Y1 - 2024/12/1

N2 - Background: Drugs used to treat rheumatic disease are associated with pneumotoxicity (drug-induced lung disease), but little is known about associated risk factors. Aim: To determine expert physician-perceived risk factors for developing pneumotoxicity in patients with rheumatologic conditions. Methods: A modified international 3-tier Delphi exercise was performed. Tier 1 determined patient and drug variables that physicians perceive to be risk factors. Tier 2 determined degree of risk associated with the Tier-1 derived variables. Tier 3 aimed to internally validate and stratify exemplar cases into risk categories. Results: 134 pulmonologists and 49 rheumatologists responded to Tier 1;157 physicians completed all tiers. Perceived risk factors included: drug type; history of previous pneumotoxicity; age; smoking; underlying rheumatic disease type and activity; renal function; pulmonary hypertension; left ventricular failure;presence, nature, severity and progression of pre-existing interstitial lung disease. Tier 2 data stratified these variables into risk profiles e.g. never versus current smoking was perceived as low and high risk respectively. An example of perceived high risk resulting from Tier 3 is a 75-year-old current smoker with high-activity rheumatoid arthritis (RA) with severe, progressive ILD being started on methotrexate. A perceived low risk is a 75-year-old currentsmoker with moderate-activity RA and emphysema with no cardiac or renal disease and no pre-existing ILD being started on rituximab. A risk prediction scoring tool is being developed to be used in validation studies. Conclusion: This modified Delphi exercise defined and stratified the perceived risk factors for developing pneumotoxicity. Age, current smoking, high underlying rheumatological disease activity, HRCT definite UIP and honeycombing, severity and progression of pre-existing ILD were perceived to be the highest risk-factors.

AB - Background: Drugs used to treat rheumatic disease are associated with pneumotoxicity (drug-induced lung disease), but little is known about associated risk factors. Aim: To determine expert physician-perceived risk factors for developing pneumotoxicity in patients with rheumatologic conditions. Methods: A modified international 3-tier Delphi exercise was performed. Tier 1 determined patient and drug variables that physicians perceive to be risk factors. Tier 2 determined degree of risk associated with the Tier-1 derived variables. Tier 3 aimed to internally validate and stratify exemplar cases into risk categories. Results: 134 pulmonologists and 49 rheumatologists responded to Tier 1;157 physicians completed all tiers. Perceived risk factors included: drug type; history of previous pneumotoxicity; age; smoking; underlying rheumatic disease type and activity; renal function; pulmonary hypertension; left ventricular failure;presence, nature, severity and progression of pre-existing interstitial lung disease. Tier 2 data stratified these variables into risk profiles e.g. never versus current smoking was perceived as low and high risk respectively. An example of perceived high risk resulting from Tier 3 is a 75-year-old current smoker with high-activity rheumatoid arthritis (RA) with severe, progressive ILD being started on methotrexate. A perceived low risk is a 75-year-old currentsmoker with moderate-activity RA and emphysema with no cardiac or renal disease and no pre-existing ILD being started on rituximab. A risk prediction scoring tool is being developed to be used in validation studies. Conclusion: This modified Delphi exercise defined and stratified the perceived risk factors for developing pneumotoxicity. Age, current smoking, high underlying rheumatological disease activity, HRCT definite UIP and honeycombing, severity and progression of pre-existing ILD were perceived to be the highest risk-factors.

KW - Drug-induced interstitial lung disease

KW - Drug-induced pneumotoxicity

KW - Interstitial lung disease

KW - Pneumotoxicity

KW - Rheumatological drugs

UR - https://www.scopus.com/pages/publications/85208290842

U2 - 10.1186/s12890-024-03287-0

DO - 10.1186/s12890-024-03287-0

M3 - Article

C2 - 39482644

SN - 1471-2466

VL - 24

JO - BMC pulmonary medicine

JF - BMC pulmonary medicine

IS - 1

M1 - 547

ER -

A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease

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UN SDGs

Keywords

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