A modified Delphi exercise in physician-perceived risk factors for drug-induced pneumotoxicity in patients with rheumatological disease.
Drug-induced interstitial lung disease
Drug-induced pneumotoxicity
Interstitial lung disease
Pneumotoxicity
Rheumatological drugs
Journal
BMC pulmonary medicine
ISSN: 1471-2466
Titre abrégé: BMC Pulm Med
Pays: England
ID NLM: 100968563
Informations de publication
Date de publication:
31 Oct 2024
31 Oct 2024
Historique:
received:
17
05
2024
accepted:
13
09
2024
medline:
1
11
2024
pubmed:
1
11
2024
entrez:
1
11
2024
Statut:
epublish
Résumé
Drugs used to treat rheumatic disease are associated with pneumotoxicity (drug-induced lung disease), but little is known about associated risk factors. To determine expert physician-perceived risk factors for developing pneumotoxicity in patients with rheumatologic conditions. 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. 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. 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.
Sections du résumé
BACKGROUND
BACKGROUND
Drugs used to treat rheumatic disease are associated with pneumotoxicity (drug-induced lung disease), but little is known about associated risk factors.
AIM
OBJECTIVE
To determine expert physician-perceived risk factors for developing pneumotoxicity in patients with rheumatologic conditions.
METHODS
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
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
CONCLUSIONS
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.
Identifiants
pubmed: 39482644
doi: 10.1186/s12890-024-03287-0
pii: 10.1186/s12890-024-03287-0
doi:
Substances chimiques
Antirheumatic Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
547Investigateurs
George W Chalmers
(GW)
Janardhana Golla
(J)
Charlotte Hyldgaard
(C)
Benjamin Chaigne
(B)
Patricia López Miguel
(P)
Elisabeth Bendstrup
(E)
Roberto G Carbone
(RG)
Albert Selva-O'Callaghan
(A)
Nazia Chaudhury
(N)
Enrico Selvi
(E)
Tonya Russell
(T)
Pedro Ferreira
(P)
Suranjan Mukherjee
(S)
Carrie Kah-Lai Leong
(C)
Tiago Alfaro
(T)
Patricia E Carreira
(PE)
Devesh J Dhasmana
(DJ)
Paolo Cameli
(P)
Wim A Wuyts
(WA)
David Bennett
(D)
Luca Novelli
(L)
Divya C Patel
(DC)
Ahmed Fahim
(A)
Margaret L Wilsher
(ML)
Adrian Shifren
(A)
Maria L Padilla
(ML)
Carolina Muller
(C)
Sergey Avdeev
(S)
Marta Dzhus
(M)
Ilias C Papanikolaou
(IC)
Yoshinori Tanino
(Y)
Harvard Fretheim
(H)
Alexandra Balbir-Gurman
(A)
Vanesa Vicens-Zygmunt
(V)
Mark G Jones
(MG)
Michael Perch
(M)
Daniel Brito de Araujo
(D)
Edoardo Conticini
(E)
V Keshavan
(V)
Shinyu Izumi
(S)
Meena Kalluri
(M)
Amy Hajari Case
(A)
Alice M Turner
(AM)
Marko Baresic
(M)
Gouri M Koduri
(GM)
Alexandre Franco Amaral
(AF)
Glenn Eiger
(G)
Mauricio Salinas
(M)
Mario Sergio Nunes
(MS)
Gin Tsen Chai
(GT)
Simone Scarlata
(S)
Elżbieta Radzikowska
(E)
Toby M Maher
(TM)
Maurizio Benucci
(M)
Katherine J Myall
(KJ)
Jesper Rømhild Davidsen
(JR)
David Launay
(D)
Dr Emma L Culver
(DEL)
Horacio Matias Castro
(HM)
H J Gayathri Devi
(HJG)
Caterina Naclerio
(C)
Ulrich A Walker
(UA)
Felix Chua
(F)
Estrella Garcia Gonzalez
(E)
Sandra Fabiana Montoya
(SF)
Sara Madelaine Carty
(SM)
Eoin P Judge
(EP)
Sarah L O'Beirne
(SL)
Kerri A Johannson
(KA)
Philippe Camus
(P)
Semra Bilaceroglu
(S)
Philip V Gardiner
(PV)
Lisa M Nicol
(LM)
Álvaro Garcia Martos
(Á)
Diego Castillo
(D)
Randolph J Lipchik
(RJ)
Fotio Drakopanagiotakis
(F)
Jens Vikse
(J)
Maria Teresa Rio Ramirez
(MTR)
Danielle Antin-Ozerkis
(D)
Rebecca Grainger
(R)
Gareth A Stewart
(GA)
Raphael Borie
(R)
Aditya Agrawal
(A)
Angela Ceribelli
(A)
Alfredo Guillen
(A)
Shigeki Saiton
(S)
Keisuke Tomii
(K)
Tracy Luckhardt
(T)
Kristin B Highland
(KB)
Ana Maria Gheorghiu
(AM)
Martin Kolb
(M)
Claudia Cobilinschi
(C)
Richard Mathew Jones
(RM)
Sergio Campainha
(S)
Edoardo Rosato
(E)
Rosario Foti
(R)
Pierre-Antoine Juge
(PA)
Shital Patil
(S)
Nasser Al Busaid
(NA)
Simona Rednic
(S)
Liudmila Garzanova
(L)
Joshua J Solomon
(JJ)
Ali Fuat Kalyoncu
(AF)
Alessandra Della Ross
(AD)
Dijana Perkovic
(D)
Yasemin Kabasakal
(Y)
Nesrin Mogulkoc
(N)
Su-Ying Low
(SY)
None Godoy
Lisa G Spencer
(LG)
Alain Delobbe
(A)
Claudia Lucia Toma
(CL)
Elvis Hysa
(E)
Davide Mohammed Reza Beiga
(DM)
Yuko Waseda
(Y)
Venero MdC
(V)
Helen Parfrey
(H)
Emma Derrett-Smith
(E)
Silvia Grazzini
(S)
Christopher J Ryerson
(CJ)
Michele Iudici
(M)
E J Nossent
(EJ)
Corrado Campochiaro
(C)
Abdulla Al-Farttoosi
(A)
Andreina Manfredi
(A)
Alejandro Robles-Perez
(A)
Ivo van der Lee
(I)
Nik Hirani
(N)
Alberto Sulli
(A)
Kristina Frketic Marovic
(KF)
Peter Saunders
(P)
Vera Bernardino
(V)
Toshiaki Matsuda
(T)
Pilar Rivera-Ortega
(P)
Virginia Berlengiero
(V)
Jadranka Morovic-Vergles
(J)
Esen Kiyan
(E)
Elisabetta Balestro
(E)
Armando Gabrielli
(A)
Marco Sebastiani
(M)
Paola Confalonieri
(P)
Bruno Crestani
(B)
H C Blum
(HC)
Gunnar Gudmundsson
(G)
Anjali Crawshaw
(A)
Alejandro Robles-Perez
(A)
Simon M Stebbings
(SM)
Sameep Sehga
(S)
Deborah Assaya
(D)
Hilario Nunes
(H)
Informations de copyright
© 2024. The Author(s).
Références
Roubille C, Haraoui B. Interstitial lung diseases induced or exacerbated by DMARDS and biologic agents in rheumatoid arthritis: a systematic literature review. Semin Arthritis Rheum. 2014;43(5):613–26.
doi: 10.1016/j.semarthrit.2013.09.005
pubmed: 24231065
Koike T, Harigai M, Inokuma S, et al. Postmarketing surveillance of safety and effectiveness of etanercept in Japanese patients with rheumatoid arthritis. Mod Rheumatol. 2011;21(4):343–51.
doi: 10.3109/s10165-010-0406-3
pubmed: 21264488
pmcid: 3152707
Dominique A, Hetland ML, Finckh A, et al. Safety outcomes in patients with rheumatoid arthritis treated with abatacept: results from a multinational surveillance study across seven European registries. Arthritis Res Ther. 2023;25(1):101.
doi: 10.1186/s13075-023-03067-x
pubmed: 37308978
pmcid: 10259009
Nasa P, Jain R, Juneja D. Delphi methodology in healthcare research: How to decide its appropriateness. World J Methodol. 2021;11(4):116–29.
doi: 10.5662/wjm.v11.i4.116
pubmed: 34322364
pmcid: 8299905
Salliot C, van der Heijde D. Long-term safety of methotrexate monotherapy in patients with rheumatoid arthritis: a systematic literature research. Ann Rheum Dis. 2009;68(7):1100–4.
doi: 10.1136/ard.2008.093690
pubmed: 19060002
Skeoch S, Weatherley N, Swift AJ, et al. Drug-induced interstitial lung disease: a systematic review. J Clin Med. 2018;7(10):356.
doi: 10.3390/jcm7100356
pubmed: 30326612
pmcid: 6209877
Conway R, Low C, Coughlan RJ, et al. Methotrexate and lung disease in rheumatoid arthritis: a meta-analysis of randomized controlled trials. Arthritis Rheumatol. 2014;66(4):803–12.
doi: 10.1002/art.38322
pubmed: 24757133
Smolen JS, Landewé RBM, Bergstra SA, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
doi: 10.1136/ard-2022-223356
pubmed: 36357155
Ledingham J, Gullick N, Irving K, et al. BSR and BHPR guideline for the prescription and monitoring of non-biologic disease-modifying anti-rheumatic drugs. Rheumatology (Oxford). 2017;56(12):2257.
doi: 10.1093/rheumatology/kex389
pubmed: 29029272
Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2021;73(7):924–39.
doi: 10.1002/acr.24596
pubmed: 34101387
Spagnolo P, Bonniaud P, Rossi G, et al. Drug-induced interstitial lung disease. Eur Respir J. 2022;60(4):2102776.
doi: 10.1183/13993003.02776-2021
pubmed: 35332071
Alarcón GS, Kremer JM, Macaluso M, et al. Risk factors for methotrexate-induced lung injury in patients with rheumatoid arthritis. a multicenter, case-control study. methotrexate-lung study group. Ann Intern Med. 1997;127(5):356–64.
doi: 10.7326/0003-4819-127-5-199709010-00003
pubmed: 9273826
Bartram SA. Experience with methotrexate-associated pneumonitis in northeastern England: comment on the article by Kremer et al. Arthritis Rheum. 1998;41(7):1327–8.
doi: 10.1002/1529-0131(199807)41:7<1327::AID-ART30>3.0.CO;2-T
pubmed: 9663497
Golden MR, Katz RS, Balk RA, et al. The relationship of preexisting lung disease to the development of ethotrexate pneumonitis in patients with rheumatoid arthritis. J Rheumatol. 1995;22(6):1043–7.
pubmed: 7674228
Kiely P, Busby AD, Nikiphorou E, et al. Is incident rheumatoid arthritis interstitial lung disease associated with methotrexate treatment? Results from a multivariate analysis in the ERAS and ERAN inception cohorts. BMJ Open. 2019;9(5):028466.
doi: 10.1136/bmjopen-2018-028466
Juge PA, Lee JS, Lau J, et al. Methotrexate and rheumatoid arthritis associated interstitial lung disease. Eur Respir J. 2021;57(2):2000337.
doi: 10.1183/13993003.00337-2020
pubmed: 32646919
pmcid: 8212188
Cottin V, Hirani NA, Hotchkin DL, et al. Presentation, diagnosis and clinical course of the spectrum of progressive-fibrosing interstitial lung diseases. Eur Respir Rev. 2018;27(150): 180076.
doi: 10.1183/16000617.0076-2018
pubmed: 30578335
pmcid: 9489068
Furukawa H, Oka S, Shimada K, et al. HLA-A*31:01 and methotrexate-induced interstitial lung disease in Japanese rheumatoid arthritis patients: a multidrug hypersensitivity marker? Ann Rheum Dis. 2013;72:153–5.
doi: 10.1136/annrheumdis-2012-201944
pubmed: 22887846
Sawada T, Inokuma S, Sato T, et al. Study committee for leflunomide-induced lung injury, Japan College of Rheumatology. Leflunomide-induced interstitial lung disease: prevalence and risk factors in Japanese patients with rheumatoid arthritis. Rheumatology (Oxford). 2009;48(9):1069–72.
doi: 10.1093/rheumatology/kep052
pubmed: 19321513