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Delphi consensus recommendations for a treatment algorithm in pulmonary sarcoidosis.

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  • 1Cleveland Clinic Florida, Weston, FL, USA.

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Expert consensus suggests glucocorticoids for initial pulmonary sarcoidosis treatment. Methotrexate or biologics like infliximab are options for severe or refractory cases, offering interim guidance for managing this challenging lung disease.

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Area of Science:

  • Pulmonology
  • Rheumatology
  • Immunology

Background:

  • Pulmonary sarcoidosis management is challenging due to limited evidence on effective therapies and disease phenotypes.
  • Expert consensus provides clinically useful guidance in the absence of definitive evidence.

Purpose of the Study:

  • To establish consensus among international experts on the pharmacological management of sarcoidosis.
  • To develop preliminary recommendations for treating pulmonary sarcoidosis.

Main Methods:

  • A modified Delphi process involving 26 international experts over three rounds.
  • Round 1: Qualitative data collection via open-ended questions.
  • Rounds 2 & 3: Quantitative assessment using an 11-point Likert scale to determine consensus.

Main Results:

  • Glucocorticoids are the consensus for initial therapy in most pulmonary sarcoidosis patients.
  • Non-biologics (e.g., methotrexate) are recommended for severe/extrapulmonary disease or steroid-sparing.
  • Biologics (e.g., TNF-α inhibitors like infliximab) may be considered as add-on therapy if non-biologics fail or are not tolerated.

Conclusions:

  • The Delphi methodology facilitated valuable insights and interim guidance for sarcoidosis management.
  • These consensus-based recommendations offer a framework while awaiting further evidence-based contributions.