ORCHESTRA Delphi Consensus: Diagnostic and Therapeutic Management of SARS-CoV-2 Infection in Rheumatological Patients.

Background: The clinical management of COVID-19 in immunocompromised patients remains a challenge. The aim of this work was 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 3 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 3 rounds, consensus was reached on 23 of the 24 questions and 10 recommendations were made.

Conclusions: The Delphi methodology allowed consensus on recommendations in areas with insufficient scientific evidence, which can be considered for decision-making in the management of rheumatological patients while awaiting better evidence.