2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T66e,Patients with Crohn's disease can have isolated or co-existent upper gastrointestinal involvement, but this is an understudied clinical manifestation. There are neither standardised definitions nor diagnostic or management recommendations to help to guide clinical practice. Therefore, we conducted a RAND/University of California Los Angeles appropriateness study on the definition, diagnosis, management, and appropriate outcomes of upper gastrointestinal Crohn's disease (UGICD). An international expert panel of 30 gastroenterologists and pathologists and two patient representatives were recruited. Following a previously published systematic review, 1061 candidate items were grouped into questions and evaluated for appropriateness. Two modified Delphi rounds of voting with an interposed moderated group discussion were performed. The expert panel defined UGICD as disease occurring in the oesophagus, stomach, and/or duodenum (proximal to the ligament of Treitz) that can occur at any time during the disease course. Upper endoscopy is appropriate only in patients with newly diagnosed or existing Crohn's disease with suspicion for upper gastrointestinal involvement (eg, upper gastrointestinal symptoms or the presence of anaemia). Management of UGICD should be determined on a case-by-case basis and factors, such as disease location and symptomatic, endoscopic, and imaging severity, should guide medical, endoscopic, and surgical intervention. Both clinical and endoscopic response and remission are appropriate treatment targets for routine clinical practice; there is uncertainty about the value of histological outcomes in UGICD.31:T66d,Despite advances in the treatment of psoriatic arthritis (PsA), a substantial proportion of patients continue to report persistent symptoms and impaired quality of life. However, terminology remains inconsistent for patients who fail to achieve disease control despite treatment, which limits research comparability and contributes to therapeutic inertia. To address this gap, a Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) task force developed consensus definitions for two distinct states: complex-to-manage PsA (C2M-PsA) and treatment-refractory PsA (TR-PsA). C2M-PsA is defined as a state of persistent symptoms despite treatment with at least one biologic or targeted synthetic DMARD (b/tsDMARD), extending beyond biological non-response to include factors such as comorbidities, overlapping conditions, psychosocial burden and treatment-related challenges (for example, non-adherence). TR-PsA, a more specific subset of C2M-PsA, is characterized by failure of at least three therapies with distinct mechanisms of action (including at least two biologic/targeted synthetic DMARDs), persistent symptoms considered problematic by both patient and clinician, and objective evidence of ongoing inflammation - after ruling out alternative explanations for treatment refractoriness. These consensus-derived GRAPPA definitions provide a shared framework to standardize terminology, support individualized care, and improve patient stratification in research and practice. Prospective validation across diverse settings and phenotypes is needed to confirm their reliability, responsiveness and clinical utility.32:T1173,F.P. has received grants and personal fees from Novartis, Eli Lilly and UCB and personal fees from AbbVie, AMGEN, BMS, Celgene, Janssen, Hexal, Medscape, Moonlake, MSD, Pfizer and Roche outside the presented work. A.L.R. has received honoraria and support for attending conferences from Novartis, Eli Lilly, UCB, AbbVie and Janssen, all outside the presented work. S.S. has received consulting fees from AbbVie, Johnson & Johnson and UCB, speaker fees from Johnson & Johnson, and research grants from AbbVie, Eli Lilly and Prometheus Biosciences. V.C. has received grants from AbbVie, Amgen and Eli Lilly and honoraria for advisory board member roles from AbbVie, BMS, Eli Lilly, Fresenius Kabi, Janssen, Novartis and UCB; V.C.’s spouse is an employee of AstraZeneca; and V.C. is supported by the Dr. Dafna D. Gladman Chair in Psoriatic Arthritis Research, a joint Hospital-University Named Chair between the University of Toronto, the University Health Network, and the UHN Foundation. W.L. has received research funding from Amgen, Janssen, Leo and Regeneron. C.L. has acted as a consultant for Tonix Pharmaceuticals, and owns stock with Amgen and Arcutis. E.R.S. has participated in advisory boards for, given conferences for and/or received grants from AbbVie, Amgen, Bristol-Myers Squibb, Elea, Glaxo, Janssen, Lilly, Montpellier, Novartis, Pfizer, Raffo, Roche, Sandoz and UCB. T.B. has received research funding from Amgen, Castle, CorEvitas, Novartis, Pfizer and Regeneron; she has served as an adviser for AbbVie, Arcutis, Aslan, Boehringer-Ingelheim, Bristol Myers Squibb, Dermavant, Galderma, Incyte, Janssen, Leo, Lilly, Pfizer, Novartis, Sanofi, Sun, Takeda and UCB; and she is a speaker for AbbVie, Amgen, Arcutis, BMS, Dermavant, Galderma, Janssen, Lilly, Leo, Ortho, Sanofi and UCB. A.D. has participated in consulting and advisory boards for Bristol Myers Squibb, Eli Lilly, J&J, Novartis, Pfizer, UCB, and has received research grants from Bristol Myers Squibb, Eli Lilly, J&J, MoonLake, Novartis, Pfizer and UCB. K.d.V. has participated in consulting and advisory boards for Bristol Myers Squibb, Eli Lilly, J&J, Novartis, Pfizer, UCB, AlfaSigma, Moonlake & Allegro, and has received research grants from Pfizer and UCB. L.E. has received grants from AbbVie, UCB, Novartis, J&J, Eli Lilly, Pfizer, Novo Nordisk, Fresenius Kabi and Amgen, and has participated in consulting for BMS, AbbVie, UCB, Novartis, J&J and Eli Lilly. M.K. has received speakers bureau fees from AbbVie, Amgen, Asahi-Kasei Pharma, Ayumi Pharma, BMS, Chugai, Daiichi Sankyo, Eisai, Janssen, Lilly, Novartis, Tanabe-Mitsubishi and UCB, and has acted as a consultant for AbbVie, Amgen, Asahi-Kasei Pharma, Ayumi Pharma, BMS, Chugai, Gilead, Janssen, Lilly, Novartis, Takeda, Tanabe-Mitsubishi and UCB. Y.Y.L. has received speaking fees from AbbVie, DKSH, Jassen, Novartis and Pfizer, outside of the present work. E.L. has received speaker´s fees from AbbVie, Lilly, Janssen, Novartis and UCB. D.M. has received grants and speaker fees from AbbVie, BMS, Novartis, Eli Lilly, UCB, Celgene, Janssen, Moonlake and Pfizer. D.P. has received research grants from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer and UCB, consulting fees from AbbVie, Eli Lilly, Greywolf Therapeutics, Janssen, Merk, Moonlake, Novartis, Pfizer and UCB, and speaker fees from AbbVie, Canon, Eli Lilly, Janssen, Medscape, Novartis, Peervoice, Pfizer and UCB; he serves as a member of the executive committee of ASAS, a member of the steering committee of GRAPPA, and editor of Therapeutic Advances in Musculoskeletal Disease . L.S. has received honoraria from AbbVie, Almirall, Novartis, Janssen, Lilly, UCB, Pfizer, Bristol-Myers-Squibb, Boehringer Ingelheim, Amgen, Medac, Moonlake, Leo Pharma, Takeda, Galderma, Biogen, Celgene, Celltrion, Sanofi and Fresenius Kabi for consulting and speaker roles, and has received support for travel from AbbVie, Janssen, Lilly, Novartis, UCB, Bristol-Myers-Squibb, Boehringer Ingelheim and Leo Pharma. F.V.d.B. has received consulting fees from AbbVie, Alfasigma, Celltrion, Eli Lilly, Fresenius Kabi, GreyWolf Therapeutics, Janssen, Novartis, UCB and Xencor. P.M. has received research grants, consulting fees and speaker fees from AbbVie, Acelyrin, Amgen, Bristol Meyers Squibb, Century, Eli Lilly, Inmagene, Johnson & Johnson, Moonlake, Novartis, Pfizer, Takeda and UCB, and is a data safety board member of Genascence.33:T8a8,The results of small studies suggest that off-label use of low-dose oral minoxidil (LDOM) may be safe and effective for patients with hair loss, but larger trials and standardized guidelines are lacking. To create an expert consensus statement for LDOM prescribing for patients with hair loss. The current literature on the pharmacological properties, adverse effect profile, and use of LDOM for patients with hair loss was reviewed. Topics of interest were identified, and a modified Delphi consensus process was created. A total of 43 hair loss specialist dermatologists from 12 countries participated in a modified Delphi process. Consensus was reached if at least 70% agreed or strongly agreed on a 5-point Likert scale. Over 4 survey rounds, 180 items in the first round, 121 items in the second round, 16 items in the third round, and 11 items in the fourth round were considered and revised. A total of 76 items achieved consensus including diagnoses for which LDOM may provide direct or supportive benefit, indications for LDOM compared to topical minoxidil, dosing for adults (18 years and older) and adolescents (aged 12 to 17 years), contraindications, precautions, baseline evaluation, monitoring, adjunctive therapy, and specialty consultation. Pediatric use and dosing items for children younger than 12 years, and LDOM titration protocols fell short of consensus. This international expert consensus statement regarding the off-label prescribing of LDOM for patients with hair loss can help guide clinical practice until more data emerge. Hair loss experts with experience treating pediatric patients were underrepresented on this expert panel. Future research should investigate best practices for LDOM use in pediatric patients. Other critical topics for further investigation include the comparative efficacy of topical minoxidil vs oral minoxidil, the safety of oral minoxidil for patients with a history of allergic contact dermatitis to topical minoxidil, the long-term safety of LDOM, and the use of other off-label forms of minoxidil, such as compounded formulations of oral minoxidil and sublingual minoxidil. As additional evidence-based data emerge, these recommendations should be updated.34:Ta86,ImportanceThe results of small studies suggest that off-label use of low-dose oral minoxidil (LDOM) may be safe and effective for patients with hair loss, but larger trials and standardized guidelines are lacking.ObjectiveTo create an expert consensus statement for LDOM prescribing for patients with hair loss.Evidence ReviewThe current literature on the pharmacological properties, adverse effect profile, and use of LDOM for patients with hair loss was reviewed. Topics of interest were identified, and a modified Delphi consensus process was created. A total of 43 hair loss specialist dermatologists from 12 countries participated in a modified Delphi process. Consensus was reached if at least 70% agreed or strongly agreed on a 5-point Likert scale.FindingsOver 4 survey rounds, 180 items in the first round, 121 items in the second round, 16 items in the third round, and 11 items in the fourth round were considered and revised. A total of 76 items achieved consensus including diagnoses for which LDOM may provide direct or supportive benefit, indications for LDOM compared to topical minoxidil, dosing for adults (18 years and older) and adolescents (aged 12 to 17 years), contraindications, precautions, baseline evaluation, monitoring, adjunctive therapy, and specialty consultation. Pediatric use and dosing items for children younger than 12 years, and LDOM titration protocols fell short of consensus.Conclusions and RelevanceThis international expert consensus statement regarding the off-label prescribing of LDOM for patients with hair loss can help guide clinical practice until more data emerge. Hair loss experts with experience treating pediatric patients were underrepresented on this expert panel. Future research should investigate best practices for LDOM use in pediatric patients. Other critical topics for further investigation include the comparative efficacy of topical minoxidil vs oral minoxidil, the safety of oral minoxidil for patients with a history of allergic contact dermatitis to topical minoxidil, the long-term safety of LDOM, and the use of other off-label forms of minoxidil, such as compounded formulations of oral minoxidil and sublingual minoxidil. As additional evidence-based data emerge, these recommendations should be updated.25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Delphi Consensus: study design Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Delphi Consensus (study design). 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Accessed October 15, 2024. https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/018154s026lbl.pdf","article-title":null,"journal-title":null,"doi-asserted-by":null}],"short-title":[],"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1,1]]}},"content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["JAMA Dermatology"],"published-print":{"date-parts":[[2025,1,1]]},"reference-count":35,"published-online":null,"references-count":35,"short-container-title":["JAMA Dermatol"],"is-referenced-by-count":5},"unpaywall":{"doi":"10.1001/jamadermatol.2024.4593","is_oa":true,"title":"Low-Dose Oral Minoxidil Initiation for Patients With Hair Loss","updated":"2025-09-06T02:51:56+00:00","published_date":"2024-11-20","best_oa_location":{"url":"https://escholarship.org/uc/item/2pp1b5gc","pmh_id":"oai:escholarship.org:ark:/13030/qt2pp1b5gc","url_for_pdf":null,"url_for_landing_page":"https://escholarship.org/uc/item/2pp1b5gc"}}},"created_at":"2025-09-20T03:51:21.142Z","updated_at":"2025-09-20T06:15:05.187Z","tags":[{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"age_group","value":"adolescent","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"brand","value":"Loniten","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"category","value":"Dermatology","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"condition","value":"Alopecia Areata","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"condition","value":"Androgenetic Alopecia","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"condition","value":"Central Centrifugal Cicatricial Alopecia","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"condition","value":"Chemotherapy-Induced Alopecia","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"condition","value":"Endocrine Therapy-Induced Alopecia","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"condition","value":"Frontal Fibrosing Alopecia","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"condition","value":"Lichen Planopilaris","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"condition","value":"Telogen Effluvium","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"generic","value":"minoxidil","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"impact_flag","value":"limited_evidence","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"level_of_evidence","value":"7","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"modality","value":"Vasodilator","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"sample_size","value":"n=43","value_numeric":43},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"study_design","value":"Delphi Consensus","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"warning","value":"Design classification reflects an expert Delphi consensus, not patient-level comparative evidence.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"warning","value":"Pediatric dosing (<12 years) and titration protocols did not reach consensus.","value_numeric":null},{"paper_doi":"10.1001/jamadermatol.2024.4593","tag_type":"warning","value":"Percentages denote panel agreement, not treatment effect sizes or event rates.","value_numeric":null}],"summaries":{"what_studied":"An international modified Delphi process among 43 hair-loss dermatologists from 12 countries (March 21, 2023–January 22, 2024) to generate consensus recommendations for initiating low-dose oral minoxidil for hair loss, with consensus defined as ≥70% agreement.","key_result":"Across 4 rounds, 76 items reached consensus, including: consider LDOM for adults and adolescents (93.0% and 86.0%); direct benefit in AGA and age‑related thinning (97.7% each); typical starting doses—female adults 1.25 mg/day (74.4%), male adults 2.5 mg/day (74.4%)—with ranges up to 5 mg/day; avoid in pregnancy/breastfeeding (95.5%); baseline labs and ECG not routine absent precautions (90.7% and 93.0%); counsel that vasodilation effects may appear in 3–7 days, fluid retention in 4–6 weeks, and earliest efficacy at 3 months.","limitations":"Findings reflect expert opinion rather than patient outcomes; pediatric experts were underrepresented and no consensus was reached for children <12 years or for titration protocols. Guidance for patients with true minoxidil allergy remains unresolved.","practice_takeaway":"When topical minoxidil is ineffective, impractical, or irritant, experts support considering LDOM in adults and adolescents, typically starting at 1.25 mg/day (female) or 2.5 mg/day (male), individualized by risk and goals, and avoiding use in pregnancy or breastfeeding. Skip routine baseline labs/ECG unless precautions exist; monitor blood pressure and counsel patients to watch for tachycardia/dizziness within 3–7 days, edema/weight gain by 4–6 weeks, and expect earliest hair response by 3 months."}}],"initialOffset":3,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"study_design","value":"Delphi Consensus"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Study Designs","href":"/hub/tag/study_design"},{"name":"Delphi Consensus"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"study_design","hub_tag_value":"Delphi Consensus"}}}]]

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