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

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.