American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic: Version 1.
Identifieur interne : 001841 ( Main/Corpus ); précédent : 001840; suivant : 001842American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic: Version 1.
Auteurs : Ted R. Mikuls ; Sindhu R. Johnson ; Liana Fraenkel ; Reuben J. Arasaratnam ; Lindsey R. Baden ; Bonnie L. Bermas ; Winn Chatham ; Stanley Cohen ; Karen Costenbader ; Ellen M. Gravallese ; Andre C. Kalil ; Michael E. Weinblatt ; Kevin Winthrop ; Amy S. Mudano ; Amy Turner ; Kenneth G. SaagSource :
- Arthritis & rheumatology (Hoboken, N.J.) [ 2326-5205 ] ; 2020.
English descriptors
- KwdEn :
- Adult (MeSH), Advisory Committees (MeSH), Angiotensin Receptor Antagonists (therapeutic use), Angiotensin-Converting Enzyme Inhibitors (therapeutic use), Anti-Inflammatory Agents, Non-Steroidal (therapeutic use), Antirheumatic Agents (therapeutic use), Betacoronavirus (MeSH), COVID-19 (MeSH), Coronavirus Infections (complications), Coronavirus Infections (epidemiology), Coronavirus Infections (prevention & control), Delivery of Health Care (MeSH), Delphi Technique (MeSH), Deprescriptions (MeSH), Glucocorticoids (therapeutic use), Humans (MeSH), Hydroxychloroquine (therapeutic use), Immunosuppressive Agents (therapeutic use), Infection Control (MeSH), Janus Kinase Inhibitors (therapeutic use), Pandemics (prevention & control), Pneumonia, Viral (complications), Pneumonia, Viral (epidemiology), Pneumonia, Viral (prevention & control), Rheumatic Diseases (complications), Rheumatic Diseases (drug therapy), Rheumatology (MeSH), SARS-CoV-2 (MeSH), Tumor Necrosis Factor Inhibitors (therapeutic use).
- MESH :
- chemical , therapeutic use : Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Anti-Inflammatory Agents, Non-Steroidal, Antirheumatic Agents, Glucocorticoids, Hydroxychloroquine, Immunosuppressive Agents, Janus Kinase Inhibitors, Tumor Necrosis Factor Inhibitors.
- complications : Coronavirus Infections, Pneumonia, Viral, Rheumatic Diseases.
- drug therapy : Rheumatic Diseases.
- epidemiology : Coronavirus Infections, Pneumonia, Viral.
- prevention & control : Coronavirus Infections, Pandemics, Pneumonia, Viral.
- Adult, Advisory Committees, Betacoronavirus, COVID-19, Delivery of Health Care, Delphi Technique, Deprescriptions, Humans, Infection Control, Rheumatology, SARS-CoV-2.
Abstract
OBJECTIVE
To provide guidance to rheumatology providers on the management of adult rheumatic disease in the context of the coronavirus disease 2019 (COVID-19) pandemic.
METHODS
A task force, including 10 rheumatologists and 4 infectious disease specialists from North America, was convened. Clinical questions were collated, and an evidence report was rapidly generated and disseminated. Questions and drafted statements were reviewed and assessed using a modified Delphi process. This included 2 rounds of asynchronous anonymous voting by e-mail and 3 webinars with the entire panel. Task force members voted on agreement with draft statements using a 1-9-point numerical scoring system, and consensus was determined to be low, moderate, or high based on the dispersion of votes. For approval, median votes were required to meet predefined levels of agreement (median values of 7-9, 4-6, and 1-3 defined as agreement, uncertainty, or disagreement, respectively) with either moderate or high levels of consensus.
RESULTS
The task force approved 77 initial guidance statements: 36 with moderate and 41 with high consensus. These were combined, resulting in 25 final guidance statements.
CONCLUSION
These guidance statements are provided to promote optimal care during the current pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document," and future updates are anticipated.
DOI: 10.1002/art.41301
PubMed: 32349183
Links to Exploration step
pubmed:32349183Le document en format XML
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<author><name sortKey="Kalil, Andre C" sort="Kalil, Andre C" uniqKey="Kalil A" first="Andre C" last="Kalil">Andre C. Kalil</name>
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<author><name sortKey="Weinblatt, Michael E" sort="Weinblatt, Michael E" uniqKey="Weinblatt M" first="Michael E" last="Weinblatt">Michael E. Weinblatt</name>
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<author><name sortKey="Winthrop, Kevin" sort="Winthrop, Kevin" uniqKey="Winthrop K" first="Kevin" last="Winthrop">Kevin Winthrop</name>
<affiliation><nlm:affiliation>Oregon Health and Science University, Portland.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Mudano, Amy S" sort="Mudano, Amy S" uniqKey="Mudano A" first="Amy S" last="Mudano">Amy S. Mudano</name>
<affiliation><nlm:affiliation>University of Alabama at Birmingham.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Turner, Amy" sort="Turner, Amy" uniqKey="Turner A" first="Amy" last="Turner">Amy Turner</name>
<affiliation><nlm:affiliation>American College of Rheumatology, Atlanta, Georgia.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Saag, Kenneth G" sort="Saag, Kenneth G" uniqKey="Saag K" first="Kenneth G" last="Saag">Kenneth G. Saag</name>
<affiliation><nlm:affiliation>University of Alabama at Birmingham.</nlm:affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en">American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic: Version 1.</title>
<author><name sortKey="Mikuls, Ted R" sort="Mikuls, Ted R" uniqKey="Mikuls T" first="Ted R" last="Mikuls">Ted R. Mikuls</name>
<affiliation><nlm:affiliation>University of Nebraska Medical Center, Omaha, Nebraska and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Johnson, Sindhu R" sort="Johnson, Sindhu R" uniqKey="Johnson S" first="Sindhu R" last="Johnson">Sindhu R. Johnson</name>
<affiliation><nlm:affiliation>Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Fraenkel, Liana" sort="Fraenkel, Liana" uniqKey="Fraenkel L" first="Liana" last="Fraenkel">Liana Fraenkel</name>
<affiliation><nlm:affiliation>Berkshire Health Systems, Pittsfield, Massachusetts, and Yale University, New Haven, Connecticut.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Arasaratnam, Reuben J" sort="Arasaratnam, Reuben J" uniqKey="Arasaratnam R" first="Reuben J" last="Arasaratnam">Reuben J. Arasaratnam</name>
<affiliation><nlm:affiliation>University of Texas Southwestern Medical Center, Dallas.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Baden, Lindsey R" sort="Baden, Lindsey R" uniqKey="Baden L" first="Lindsey R" last="Baden">Lindsey R. Baden</name>
<affiliation><nlm:affiliation>Brigham and Women's Hospital, Boston, Massachusetts.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Bermas, Bonnie L" sort="Bermas, Bonnie L" uniqKey="Bermas B" first="Bonnie L" last="Bermas">Bonnie L. Bermas</name>
<affiliation><nlm:affiliation>University of Texas Southwestern Medical Center, Dallas.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Chatham, Winn" sort="Chatham, Winn" uniqKey="Chatham W" first="Winn" last="Chatham">Winn Chatham</name>
<affiliation><nlm:affiliation>University of Alabama at Birmingham.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Cohen, Stanley" sort="Cohen, Stanley" uniqKey="Cohen S" first="Stanley" last="Cohen">Stanley Cohen</name>
<affiliation><nlm:affiliation>Metroplex Clinical Research Center, Dallas, Texas.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Costenbader, Karen" sort="Costenbader, Karen" uniqKey="Costenbader K" first="Karen" last="Costenbader">Karen Costenbader</name>
<affiliation><nlm:affiliation>Brigham and Women's Hospital, Boston, Massachusetts.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Gravallese, Ellen M" sort="Gravallese, Ellen M" uniqKey="Gravallese E" first="Ellen M" last="Gravallese">Ellen M. Gravallese</name>
<affiliation><nlm:affiliation>Brigham and Women's Hospital, Boston, Massachusetts.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Kalil, Andre C" sort="Kalil, Andre C" uniqKey="Kalil A" first="Andre C" last="Kalil">Andre C. Kalil</name>
<affiliation><nlm:affiliation>University of Nebraska Medical Center, Omaha.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Weinblatt, Michael E" sort="Weinblatt, Michael E" uniqKey="Weinblatt M" first="Michael E" last="Weinblatt">Michael E. Weinblatt</name>
<affiliation><nlm:affiliation>Brigham and Women's Hospital, Boston, Massachusetts.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Winthrop, Kevin" sort="Winthrop, Kevin" uniqKey="Winthrop K" first="Kevin" last="Winthrop">Kevin Winthrop</name>
<affiliation><nlm:affiliation>Oregon Health and Science University, Portland.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Mudano, Amy S" sort="Mudano, Amy S" uniqKey="Mudano A" first="Amy S" last="Mudano">Amy S. Mudano</name>
<affiliation><nlm:affiliation>University of Alabama at Birmingham.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Turner, Amy" sort="Turner, Amy" uniqKey="Turner A" first="Amy" last="Turner">Amy Turner</name>
<affiliation><nlm:affiliation>American College of Rheumatology, Atlanta, Georgia.</nlm:affiliation>
</affiliation>
</author>
<author><name sortKey="Saag, Kenneth G" sort="Saag, Kenneth G" uniqKey="Saag K" first="Kenneth G" last="Saag">Kenneth G. Saag</name>
<affiliation><nlm:affiliation>University of Alabama at Birmingham.</nlm:affiliation>
</affiliation>
</author>
</analytic>
<series><title level="j">Arthritis & rheumatology (Hoboken, N.J.)</title>
<idno type="eISSN">2326-5205</idno>
<imprint><date when="2020" type="published">2020</date>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult (MeSH)</term>
<term>Advisory Committees (MeSH)</term>
<term>Angiotensin Receptor Antagonists (therapeutic use)</term>
<term>Angiotensin-Converting Enzyme Inhibitors (therapeutic use)</term>
<term>Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)</term>
<term>Antirheumatic Agents (therapeutic use)</term>
<term>Betacoronavirus (MeSH)</term>
<term>COVID-19 (MeSH)</term>
<term>Coronavirus Infections (complications)</term>
<term>Coronavirus Infections (epidemiology)</term>
<term>Coronavirus Infections (prevention & control)</term>
<term>Delivery of Health Care (MeSH)</term>
<term>Delphi Technique (MeSH)</term>
<term>Deprescriptions (MeSH)</term>
<term>Glucocorticoids (therapeutic use)</term>
<term>Humans (MeSH)</term>
<term>Hydroxychloroquine (therapeutic use)</term>
<term>Immunosuppressive Agents (therapeutic use)</term>
<term>Infection Control (MeSH)</term>
<term>Janus Kinase Inhibitors (therapeutic use)</term>
<term>Pandemics (prevention & control)</term>
<term>Pneumonia, Viral (complications)</term>
<term>Pneumonia, Viral (epidemiology)</term>
<term>Pneumonia, Viral (prevention & control)</term>
<term>Rheumatic Diseases (complications)</term>
<term>Rheumatic Diseases (drug therapy)</term>
<term>Rheumatology (MeSH)</term>
<term>SARS-CoV-2 (MeSH)</term>
<term>Tumor Necrosis Factor Inhibitors (therapeutic use)</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Angiotensin Receptor Antagonists</term>
<term>Angiotensin-Converting Enzyme Inhibitors</term>
<term>Anti-Inflammatory Agents, Non-Steroidal</term>
<term>Antirheumatic Agents</term>
<term>Glucocorticoids</term>
<term>Hydroxychloroquine</term>
<term>Immunosuppressive Agents</term>
<term>Janus Kinase Inhibitors</term>
<term>Tumor Necrosis Factor Inhibitors</term>
</keywords>
<keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
<term>Rheumatic Diseases</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Rheumatic Diseases</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pandemics</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Advisory Committees</term>
<term>Betacoronavirus</term>
<term>COVID-19</term>
<term>Delivery of Health Care</term>
<term>Delphi Technique</term>
<term>Deprescriptions</term>
<term>Humans</term>
<term>Infection Control</term>
<term>Rheumatology</term>
<term>SARS-CoV-2</term>
</keywords>
</textClass>
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<front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b>
</p>
<p>To provide guidance to rheumatology providers on the management of adult rheumatic disease in the context of the coronavirus disease 2019 (COVID-19) pandemic.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>METHODS</b>
</p>
<p>A task force, including 10 rheumatologists and 4 infectious disease specialists from North America, was convened. Clinical questions were collated, and an evidence report was rapidly generated and disseminated. Questions and drafted statements were reviewed and assessed using a modified Delphi process. This included 2 rounds of asynchronous anonymous voting by e-mail and 3 webinars with the entire panel. Task force members voted on agreement with draft statements using a 1-9-point numerical scoring system, and consensus was determined to be low, moderate, or high based on the dispersion of votes. For approval, median votes were required to meet predefined levels of agreement (median values of 7-9, 4-6, and 1-3 defined as agreement, uncertainty, or disagreement, respectively) with either moderate or high levels of consensus.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>The task force approved 77 initial guidance statements: 36 with moderate and 41 with high consensus. These were combined, resulting in 25 final guidance statements.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSION</b>
</p>
<p>These guidance statements are provided to promote optimal care during the current pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document," and future updates are anticipated.</p>
</div>
</front>
</TEI>
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<DateCompleted><Year>2020</Year>
<Month>11</Month>
<Day>26</Day>
</DateCompleted>
<DateRevised><Year>2020</Year>
<Month>12</Month>
<Day>18</Day>
</DateRevised>
<Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">2326-5205</ISSN>
<JournalIssue CitedMedium="Internet"><Volume>72</Volume>
<Issue>8</Issue>
<PubDate><Year>2020</Year>
<Month>08</Month>
</PubDate>
</JournalIssue>
<Title>Arthritis & rheumatology (Hoboken, N.J.)</Title>
<ISOAbbreviation>Arthritis Rheumatol</ISOAbbreviation>
</Journal>
<ArticleTitle>American College of Rheumatology Guidance for the Management of Rheumatic Disease in Adult Patients During the COVID-19 Pandemic: Version 1.</ArticleTitle>
<Pagination><MedlinePgn>1241-1251</MedlinePgn>
</Pagination>
<ELocationID EIdType="doi" ValidYN="Y">10.1002/art.41301</ELocationID>
<Abstract><AbstractText Label="OBJECTIVE">To provide guidance to rheumatology providers on the management of adult rheumatic disease in the context of the coronavirus disease 2019 (COVID-19) pandemic.</AbstractText>
<AbstractText Label="METHODS">A task force, including 10 rheumatologists and 4 infectious disease specialists from North America, was convened. Clinical questions were collated, and an evidence report was rapidly generated and disseminated. Questions and drafted statements were reviewed and assessed using a modified Delphi process. This included 2 rounds of asynchronous anonymous voting by e-mail and 3 webinars with the entire panel. Task force members voted on agreement with draft statements using a 1-9-point numerical scoring system, and consensus was determined to be low, moderate, or high based on the dispersion of votes. For approval, median votes were required to meet predefined levels of agreement (median values of 7-9, 4-6, and 1-3 defined as agreement, uncertainty, or disagreement, respectively) with either moderate or high levels of consensus.</AbstractText>
<AbstractText Label="RESULTS">The task force approved 77 initial guidance statements: 36 with moderate and 41 with high consensus. These were combined, resulting in 25 final guidance statements.</AbstractText>
<AbstractText Label="CONCLUSION">These guidance statements are provided to promote optimal care during the current pandemic. However, given the low level of available evidence and the rapidly evolving literature, this guidance is presented as a "living document," and future updates are anticipated.</AbstractText>
<CopyrightInformation>© 2020, American College of Rheumatology.</CopyrightInformation>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Mikuls</LastName>
<ForeName>Ted R</ForeName>
<Initials>TR</Initials>
<Identifier Source="ORCID">0000-0002-0897-2272</Identifier>
<AffiliationInfo><Affiliation>University of Nebraska Medical Center, Omaha, Nebraska and VA Nebraska-Western Iowa Health Care System, Omaha, Nebraska.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Johnson</LastName>
<ForeName>Sindhu R</ForeName>
<Initials>SR</Initials>
<Identifier Source="ORCID">0000-0003-0591-2976</Identifier>
<AffiliationInfo><Affiliation>Toronto Western Hospital, Mount Sinai Hospital, and University of Toronto, Toronto, Ontario, Canada.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Fraenkel</LastName>
<ForeName>Liana</ForeName>
<Initials>L</Initials>
<Identifier Source="ORCID">0000-0002-6148-610X</Identifier>
<AffiliationInfo><Affiliation>Berkshire Health Systems, Pittsfield, Massachusetts, and Yale University, New Haven, Connecticut.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Arasaratnam</LastName>
<ForeName>Reuben J</ForeName>
<Initials>RJ</Initials>
<AffiliationInfo><Affiliation>University of Texas Southwestern Medical Center, Dallas.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Baden</LastName>
<ForeName>Lindsey R</ForeName>
<Initials>LR</Initials>
<AffiliationInfo><Affiliation>Brigham and Women's Hospital, Boston, Massachusetts.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Bermas</LastName>
<ForeName>Bonnie L</ForeName>
<Initials>BL</Initials>
<AffiliationInfo><Affiliation>University of Texas Southwestern Medical Center, Dallas.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Chatham</LastName>
<ForeName>Winn</ForeName>
<Initials>W</Initials>
<AffiliationInfo><Affiliation>University of Alabama at Birmingham.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Cohen</LastName>
<ForeName>Stanley</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Metroplex Clinical Research Center, Dallas, Texas.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Costenbader</LastName>
<ForeName>Karen</ForeName>
<Initials>K</Initials>
<AffiliationInfo><Affiliation>Brigham and Women's Hospital, Boston, Massachusetts.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Gravallese</LastName>
<ForeName>Ellen M</ForeName>
<Initials>EM</Initials>
<AffiliationInfo><Affiliation>Brigham and Women's Hospital, Boston, Massachusetts.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Kalil</LastName>
<ForeName>Andre C</ForeName>
<Initials>AC</Initials>
<AffiliationInfo><Affiliation>University of Nebraska Medical Center, Omaha.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Weinblatt</LastName>
<ForeName>Michael E</ForeName>
<Initials>ME</Initials>
<AffiliationInfo><Affiliation>Brigham and Women's Hospital, Boston, Massachusetts.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Winthrop</LastName>
<ForeName>Kevin</ForeName>
<Initials>K</Initials>
<AffiliationInfo><Affiliation>Oregon Health and Science University, Portland.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Mudano</LastName>
<ForeName>Amy S</ForeName>
<Initials>AS</Initials>
<AffiliationInfo><Affiliation>University of Alabama at Birmingham.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Turner</LastName>
<ForeName>Amy</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>American College of Rheumatology, Atlanta, Georgia.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Saag</LastName>
<ForeName>Kenneth G</ForeName>
<Initials>KG</Initials>
<AffiliationInfo><Affiliation>University of Alabama at Birmingham.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016446">Consensus Development Conference</PublicationType>
<PublicationType UI="D016428">Journal Article</PublicationType>
<PublicationType UI="D017065">Practice Guideline</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic"><Year>2020</Year>
<Month>06</Month>
<Day>05</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo><Country>United States</Country>
<MedlineTA>Arthritis Rheumatol</MedlineTA>
<NlmUniqueID>101623795</NlmUniqueID>
<ISSNLinking>2326-5191</ISSNLinking>
</MedlineJournalInfo>
<ChemicalList><Chemical><RegistryNumber>0</RegistryNumber>
<NameOfSubstance UI="D057911">Angiotensin Receptor Antagonists</NameOfSubstance>
</Chemical>
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