Understanding disease modifying antirheumatic drug use in older adults with late-onset rheumatoid arthritis

了解患有晚发性类风湿性关节炎的老年人的疾病缓解抗风湿药物的使用

基本信息

批准号：
10713765
负责人：
JIHA LEE
金额：
$ 19.44万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-20 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10713765
关键词：
Acceleration Acute Adverse effects Affect Age Age Years Aging Attitude Biological Caring Chronic Clinical Clinical Practice Guideline Clinical Trials Combination Drug Therapy Communication Data Dedications Development Diagnosis Disease Disease-Modifying Second-Line Drugs Dose Drug usage Elderly Environment Evaluation Exclusion Exclusion Criteria Foundations Frequencies Future Glucocorticoids Goals Guidelines Healthcare Infection Inflammatory Interview Kidney Knowledge Liver Failure Low income Malignant neoplasm of liver Measures Medicare claim Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methodology Methods Michigan Monitor Newly Diagnosed Observational Study Outcome Patient Care Patient Preferences Patients Pharmaceutical Preparations Pharmacoepidemiology Pharmacotherapy Population Prednisone Primary Care Physician Provider Qualifying Recommendation Regimen Research Research Methodology Research Personnel Research Proposals Rheumatism Rheumatoid Arthritis Rheumatology Risk Role Sampling Science Scientist Steroids Structure Time Toxic effect Training Treatment Protocols Treatment outcome Universities Update Visit Vulnerable Populations Work career development clinical practice clinically relevant cohort comorbidity disability evidence base experience human old age (65+)improved indexing multilevel analysis opioid use osteoporosis with pathological fracture patient engagement population based professor public health relevance radiological imaging rheumatologist standard of care symptomatic improvement treatment and outcome treatment as usual treatment choice

Acceleration Acute Adverse effects Affect Age Age Years Aging Attitude Biological Caring Chronic Clinical Clinical Practice Guideline Clinical Trials Combination Drug Therapy Communication Data Dedications Development Diagnosis Disease Disease-Modifying Second-Line Drugs Dose Drug usage Elderly Environment Evaluation Exclusion Exclusion Criteria Foundations Frequencies Future Glucocorticoids Goals Guidelines Healthcare Infection Inflammatory Interview Kidney Knowledge Liver Failure Low income Malignant neoplasm of liver Measures Medicare claim Mentored Patient-Oriented Research Career Development Award Mentors Mentorship Methodology Methods Michigan Monitor Newly Diagnosed Observational Study Outcome Patient Care Patient Preferences Patients Pharmaceutical Preparations Pharmacoepidemiology Pharmacotherapy Population Prednisone Primary Care Physician Provider Qualifying Recommendation Regimen Research Research Methodology Research Personnel Research Proposals Rheumatism Rheumatoid Arthritis Rheumatology Risk Role Sampling Science Scientist Steroids Structure Time Toxic effect Training Treatment Protocols Treatment outcome Universities Update Visit Vulnerable Populations Work career development clinical practice clinically relevant cohort comorbidity disability evidence base experience human old age (65+)improved indexing multilevel analysis opioid use osteoporosis with pathological fracture patient engagement population based professor public health relevance radiological imaging rheumatologist standard of care symptomatic improvement treatment and outcome treatment as usual treatment choice

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项目摘要

PROJECT SUMMARY/ABSTRACT Rheumatoid arthritis (RA) is a chronic, debilitating inflammatory disease that affects 1.3 million older adults in the US. The number of older adults living with RA is growing and one-third are diagnosed with late-onset RA (LORA), characterized by more severe disease, greater comorbidity burden at time of diagnosis, and disability. Older adults with RA are less likely to receive effective disease modifying antirheumatic drugs (DMARDs) and more likely to receive long-term glucocorticoids alone for treatment which suggest we may be accepting less than optimal management in this population and better outcomes may be achievable. Dr. Jiha Lee is an Assistant Professor at the University of Michigan whose long-term goal is to become an independent investigator and national leader in geriatric rheumatology focused on advancing the science of effective medication use to improve the care of older adults with rheumatic diseases. This K23 Mentored Patient- Oriented Research Career Development Award application (PA-20-205) will support Dr. Lee to gain additional training and mentoring, and by completing the proposed work to become one of the few clinician-scientists with unique qualifications at the intersection of rheumatology, aging, pharmacoepidemiology, and mixed methods research to conduct rigorous aging research in the field of rheumatology. The overarching scientific goal of this mentored-research proposal is to investigate suboptimal DMARD use and tolerability to different treatment regimens in usual care among older adults with LORA and to engage patients and providers to better understand observed outcomes. The proposed explanatory sequential mixed methods study will use nationally representative Medicare claims data for Aims 1 and 2, followed by in-depth semi-structured interviews with patients and providers for Aim 3. Specifically, in Aim 1, Dr. Lee will examine patient and provider/healthcare factors associated with suboptimal DMARD use in older adults with LORA during the first 12 months after index date of diagnosis, gathering critical information to identify targets for future efforts to improve DMARD use. To build toward more evidence-based prescribing, in Aim 2 she will examine outcomes associated with different treatment regimens and identify patients at greatest risk of poor outcomes. In Aim 3, she will use the results from Aims 1 and 2 to guide the sampling strategy and discussion guide development to engage patients with LORA and providers to examine and inform additional potentially important factors that drive treatment approaches. Dr. Lee will conduct all work at the rich environment of the University of Michigan, with guidance from her exceptional team of mentors and advisors led by Dr. Julie Bynum. The proposed work will lay the foundation to identify subpopulations at risk of poor outcomes and build the evidence base for an R01-level application to inform development and evaluation of age-appropriate approaches to treatment of LORA.

项目摘要/摘要类风湿关节炎（RA）是一种慢性，令人衰弱的炎症性疾病，影响130万老年人美国。患有RA的老年人的数量正在增长，三分之一被诊断出患有RA的迟发（Lora），其特征是诊断时更严重的疾病，合并症负担更大，残疾负担更大。患有RA的老年人不太可能接受有效的疾病，以修饰抗疾病药物（DMARDS）和更可能仅接受长期糖皮质激素进行治疗，这表明我们可能接受的糖皮质激素可能更少比该人群中的最佳管理和更好的结果可以实现。 Jiha Lee博士是密歇根大学的助理教授的长期目标是成为独立老年流变学的研究者兼国家领导者致力于推进有效的科学用药用来改善风湿病的老年人护理。这个K23指导患者 - 面向研究的研究职业发展奖申请（PA-20-205）将支持李博士获得更多培训和指导，并完成拟议的工作，成为少数几位临床医生的工作者之一风湿病，衰老，药物学和混合方法的交集中的独特资格在风湿病领域进行严格衰老研究的研究。总体科学目标指导研究的建议是调查次优的DMARD使用和对不同治疗的耐受性患有洛拉（Lora）的老年人的通常护理方案，使患者和提供者与之相比了解观察到的结果。拟议的解释性顺序混合方法研究将在全国使用代表Medicare要求目标1和2的数据，然后进行深入的半结构化访谈 AIM 3的患者和提供者。特别是，在AIM 1中，Lee博士将检查患者和提供者/医疗保健与洛拉（Lora）老年人在洛拉（Lora 索引诊断日期，收集关键信息，以确定未来改善DMARD的目标的目标使用。为了建立更多基于证据的处方，在AIM 2中，她将检查与不同的治疗方案并识别出最大预后风险的患者。在AIM 3中，她将使用目标1和2的结果指导抽样策略和讨论指南开发以吸引患者与洛拉（Lora）和提供者一起检查并告知其他潜在的潜在重要因素，以驱动治疗方法。李博士将在密歇根大学丰富的环境中进行所有工作，并在指导下来自她由朱莉·拜纳姆（Julie Bynum）博士领导的杰出导师和顾问团队。拟议的工作将放置基础，以确定有差结果的风险的亚群，并建立R01级的证据基础适用于适合年龄的劳拉治疗方法的开发和评估。