S0880 Examining the Link Between Autoimmune Disease and Thromboembolic Events: A Modified Delphi Panel Approach

INTRODUCTION: While there is a growing body of evidence connecting thromboembolic events (TEs) in patients with Immune-Mediated Disease (IMD), physician understanding and awareness of this relationship varies. Therefore, a multidisciplinary panel of physicians was convened utilizing a modified Delphi approach, to gain understanding on the relationship between TEs and IMDs. The primary objective of the panel was to assess areas of consensus on the IMD most prone to TE as well as modifiable and unmodifiable factors that might exacerbate the risk of TEs. METHODS: Thirteen nationally recognized physicians from the fields of cardiology, dermatology, gastroenterology, neurology, pulmonology, and rheumatology were selected based on their contributions to guidelines, publications, and patient care. The modified Delphi panel consisted of four rounds of engagement based on IMD/TE relationships assessed from a rapid evidence literature review as background information prior to the panel: (1) a semi-structured interview, (2) an expert panel questionnaire, (3) an in-person panel discussion, and (4) a consensus statement survey. RESULTS: Ulcerative colitis (UC) and Crohn’s disease (CD) were identified as two of four IMDs with the highest TE risk along with lupus and rheumatoid arthritis. Consensus was reached on several non-modifiable (e.g., prior clotting event, age) and modifiable characteristics (e.g., disease activity, oral contraceptive) of high-risk. The panel identified various approaches to reduce TE incidence that included altering treatment approach, requiring the monitoring of patients for TEs, and modifying patient behaviors. JAKi and corticosteroids were identified as treatment modalities that required further evaluation given their potential TE risk. In addition, 92% of the experts agreed/slightly agreed that caution should be used when prescribing medications associated with an increased risk of TE. CONCLUSION: The multidisciplinary panel reached a consensus that several IMDs are at an elevated risk of TEs, including UC and CD. While physicians are unable to control patient level risk factors, they can control what therapy is being used to treat these conditions. Consequently, physicians should take into consideration the specific IMD, be aware of TE risk factors, and take into account modifiable and unmodifiable risk factors in selecting the most appropriate therapies to optimally manage their conditions and to reduce the risk of TEs in this population.