Using a modified Delphi process to establish clinical consensus for the diagnosis, risk assessment and abatacept treatment in patients with aggressive rheumatoid arthritis

Objective We aimed to formulate consensus statements for the identification of patients with rheumatoid arthritis (RA) who may benefit most from abatacept treatment, in order to clear up points related to its use in rheumatology. Methods Two rounds of a modified Delphi process were conducted. In the first round, a board of experts defined a list of consensus statements based on data derived from a non-systematic review on the use of abatacept in adult RA patients. In the second round, clinicians with extensive experience in the treatment of RA were invited to express individually agreement on the statements, using a dedicated online platform. A face-to-face meeting of the board was held after round two. Consensus was defined as 75% agreement. Results In Delphi process round one, a board of 10 experts defined a list of 20 consensus statements on abatacept treatment. Then, a panel of 37 rheumatologists participated in round two. The majority of clinicians (75.7%) had 10 or more years of experience in the treatment of RA patients. Fifteen of the 20 statements reached the defined level of consensus. Conclusion Identified consensus statements may help clinicians to apply to routine-care settings results from clinical studies and clinical recommendations, providing a guide for the initiation of abatacept treatment in RA patients.