Management of repository corticotrophin injection therapy for pulmonary sarcoidosis: a Delphi study. (20th March 2020)

• Record Type: Journal Article
• Authors: Rahaghi, Franck F.; Sweiss, Nadera J.; Saketkoo, Lesley Ann; Scholand, Mary Beth; Barney, Joseph B.; Gerke, Alicia K.; Lower, Elyse E.; Mirsaeidi, Mehdi; O'Hare, Lanier; Rumbak, Mark J.; Samavati, Lobelia; Baughman, Robert P.
• Is Part Of: European respiratory review. Volume 29:Number 155(2020)
• Publication Date: 2020-03-20
• Subjects: Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases; Respiratory organs -- Diseases; Respiratory organs -- Diseases -- Treatment; Electronic journals; Periodical; Periodicals; Periodicals; 616.2
• DOI: 10.1183/16000617.0147-2019
• Languages: English
• ISSNs: 0905-9180

Abstract

In patients treated with repository corticotrophin injection (RCI) for pulmonary sarcoidosis, effective management of adverse events may improve adherence. However, management of adverse events may be challenging due to limitations in real-world clinical experience with RCI and available published guidelines. We surveyed 12 physicians with a modified Delphi process using three questionnaires. Questionnaire 1 consisted of open-ended questions. Panellists' answers were developed into a series of statements for Questionnaires 2 and 3. In these, physicians rated their agreement with the statements using a Likert scale. Key consensus recommendations included a starting dose of 40 units twice a week for patients with less severe disease, continued at a maintenance dose for patients who responded, particularly those with chronic refractory sarcoidosis. Panellists reached consensus that concomitant steroids should be quickly tapered in patients receiving RCI, but that concomitant use of immunosuppressive medications should be continued. Panellists developed consensus recommendations for adverse event management, and reached consensus that RCI should be down-titrated or discontinued if other interventions for the adverse effects fail or if the adverse effect is severe. In the absence of clinical evidence, our Delphi consensus opinions may provide practical guidance to physicians on the management of RCI to treat pulmonary sarcoidosis. In this paper, a modified Delphi method was used to develop an expert consensus on the use of repository corticotrophin injection therapy for pulmonary sarcoidosis, including dosing, concomitant medications, contraindications and adverse event management. http://bit.ly/2TyauZp