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Connective tissue disease related interstitial lung diseases and idiopathic pulmonary fibrosis: provisional core sets of domains and instruments for use in clinical trials
  1. Lesley Ann Saketkoo1,
  2. Shikha Mittoo2,
  3. Dörte Huscher3,4,
  4. Dinesh Khanna5,
  5. Paul F Dellaripa6,
  6. Oliver Distler7,
  7. Kevin R Flaherty5,
  8. Sid Frankel8,
  9. Chester V Oddis9,
  10. Christopher P Denton10,
  11. Aryeh Fischer11,
  12. Otylia M Kowal-Bielecka12,
  13. Daphne LeSage13,
  14. Peter A Merkel14,
  15. Kristine Phillips5,
  16. David Pittrow15,
  17. Jeffrey Swigris11,
  18. Katerina Antoniou16,
  19. Robert P Baughman17,
  20. Flavia V Castelino18,
  21. Romy B Christmann19,
  22. Lisa Christopher-Stine20,
  23. Harold R Collard21,
  24. Vincent Cottin22,
  25. Sonye Danoff20,
  26. Kristin B Highland23,
  27. Laura Hummers20,
  28. Ami A Shah20,
  29. Dong Soon Kim24,
  30. David A Lynch11,
  31. Frederick W Miller25,
  32. Susanna M Proudman26,
  33. Luca Richeldi27,
  34. Jay H Ryu28,
  35. Nora Sandorfi14,
  36. Catherine Sarver29,
  37. Athol U Wells30,
  38. Vibeke Strand31,
  39. Eric L Matteson28,
  40. Kevin K Brown11,
  41. James R Seibold32
  1. 1Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
  2. 2University of Toronto, Toronto, Canada
  3. 3German Rheumatism Research Centre, Berlin, Germany
  4. 4Charité Universitaetsmedizin, Berlin, Germany
  5. 5University of Michigan, Ann Arbor, Michigan, USA
  6. 6Brigham and Womens Hospital, Boston, Massachusetts, USA
  7. 7University Hospital Zurich, Zurich, Switzerland
  8. 8University of Manitoba, Manitoba, Canada
  9. 9University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  10. 10Royal Free Hospital, London, UK
  11. 11National Jewish Health, Denver, Colorado, USA
  12. 12Medical University of Bialystok, Bialystok, Poland
  13. 13Patient Research Partner, Office of Public Health, New Orleans, Louisiana, USA
  14. 14University of Pennsylvania, Philadelphia, Pennsylvania, USA
  15. 15University of Dresden, Dresden, Germany
  16. 16University of Crete, Heraklion, Greece
  17. 17University of Cincinnati, Cincinnati, Ohio, USA
  18. 18Massachusetts General Hospital, Boston, Massachusetts, USA
  19. 19Boston University School of Medicine, Boston, Massachusetts, USA
  20. 20Johns Hopkins University, Baltimore, Maryland, USA
  21. 21University of California-San Francisco, San Francisco, California, USA
  22. 22Claude Bernard University, Lyon, France
  23. 23Cleveland Clinic, Cleveland, Ohio, USA
  24. 24Asan Medical Center University of Ulsan, Ulsan, South Korea
  25. 25National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
  26. 26University of Adelaide, Adelaide, Australia
  27. 27Respiratory Biomedical Research Unit, University of Southampton, UK
  28. 28Mayo Clinic College of Medicine, Rochester, Minnesota, USA
  29. 29Patient Research Partner, Maryland, USA
  30. 30Royal Brompton Hospital and National Heart and Lung Institute, London, UK
  31. 31Stanford University, Palo Alto, California, USA
  32. 32Scleroderma Research Consultants, LLC, Avon, Connecticut, USA
  1. Correspondence to Dr Lesley Ann Saketkoo, Department of Medicine, Sections of Rheumatology and Pulmonary Medicine and Critical Care, Louisiana State University Health Sciences Center—New Orleans, LSU Scleroderma and Sarcoidosis Patient Care and Research Center, 1542 Tulane Avenue, New Orleans, LA 70112, USA; ctd.ild{at}gmail.com, lsake1{at}lsuhsc.edu

Abstract

Rationale Clinical trial design in interstitial lung diseases (ILDs) has been hampered by lack of consensus on appropriate outcome measures for reliably assessing treatment response. In the setting of connective tissue diseases (CTDs), some measures of ILD disease activity and severity may be confounded by non-pulmonary comorbidities.

Methods The Connective Tissue Disease associated Interstitial Lung Disease (CTD-ILD) working group of Outcome Measures in Rheumatology—a non-profit international organisation dedicated to consensus methodology in identification of outcome measures—conducted a series of investigations which included a Delphi process including >248 ILD medical experts as well as patient focus groups culminating in a nominal group panel of ILD experts and patients. The goal was to define and develop a consensus on the status of outcome measure candidates for use in randomised controlled trials in CTD-ILD and idiopathic pulmonary fibrosis (IPF).

Results A core set comprising specific measures in the domains of lung physiology, lung imaging, survival, dyspnoea, cough and health-related quality of life is proposed as appropriate for consideration for use in a hypothetical 1-year multicentre clinical trial for either CTD-ILD or IPF. As many widely used instruments were found to lack full validation, an agenda for future research is proposed.

Conclusion Identification of consensus preliminary domains and instruments to measure them was attained and is a major advance anticipated to facilitate multicentre RCTs in the field.

  • Connective tissue disease associated lung disease
  • Interstitial Fibrosis
  • Idiopathic pulmonary fibrosis
  • Rheumatoid lung disease
  • Systemic disease and lungs

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/

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