Evaluation of treatment patterns and prescription medication use among older adults with late-onset rheumatoid arthritis

晚发性类风湿性关节炎老年人的治疗模式和处方药使用评估

基本信息

批准号：
10027364
负责人：
JIHA LEE
金额：
$ 15.41万
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：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2022-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10027364
关键词：
Acute Address Adverse effects Affect Age Aging Americas Award Behavior Biological Capsicum Caring Characteristics Chronic Clinical Complex Cost of Illness Data Data Analyses Development Diagnosis Diagnostic radiologic examination Disease Disease remission Disease-Modifying Second-Line Drugs Dose Drug Prescriptions Drug usage Elderly Eligibility Determination Emergency department visit Evaluation Fracture Frequencies Future Glucocorticoids Goals Health Healthcare Hospitalization Incidence Infection Inflammation Inflammatory K-Series Research Career Programs Knowledge Life Expectancy Medical Medicare Medicare claim Mentors Mentorship Michigan Modeling Non-Steroidal Anti-Inflammatory Agents Observational Study Older Population Opioid Osteoporosis Outcome Outcome Measure Pain management Patients Pattern Pharmaceutical Preparations Polypharmacy Population Population Study Quality of Care Randomized Controlled Trials Regimen Research Research Personnel Resources Retrospective cohort study Rheumatism Rheumatoid Arthritis Risk Role Training Treatment Protocols Universities Variant aggressive therapy career career development cohort cost design disability education research experience fall risk functional decline functional outcomes health care delivery high risk human old age (65+)improved improved outcome indexing interest multiple chronic conditions older patient opioid use public health relevance skills treatment as usual treatment choice

项目摘要

PROJECT SUMMARY / ABSTRACT Rheumatoid arthritis (RA) is a chronic, debilitating and costly disease that disproportionally affects older adults. Disease modifying antirheumatic drugs (DMARDs) improve outcomes of RA and, in recent years, the treatment paradigm has evolved to promote early initiation, escalation, and combination of DMARDs. And yet, older adults are less likely to receive aggressive treatment due to issues of polypharmacy and multimorbidity. Older adults with late-onset RA (LORA) experience higher disease activity, more radiographic progression, and greater functional decline. Thus, less aggressive treatment raises greater concerns for poorer outcomes and greater levels of disability among older adults with LORA. In addition to achieving disease remission, pain control is an important goal in the treatment of RA and prescription medications including NSAIDS, glucocorticoids and opioids are in common use among patients with RA. However, these prescription medications are generally considered inappropriate for use in older adults because of associated adverse effects such as risk of falls, fractures and osteoporosis. Moreover, older adults have more limited tolerance to common adverse effects of medications and are more prone to the additive or even multiplicative risk of polypharmacy, further complicating the care of medically complex older adults with RA. Information on use of DMARDs for new diagnosis of LORA, and potential unintentional reliance on other prescription medication use is scarce because older adults are often excluded from randomized controlled trials. This leaves a gap in our understanding of how, in the face of polypharmacy and multimorbidity, variation in patterns of treatment impact outcomes for medically complex older adults with RA. In the absence of trial data, large observational studies that leverage administrative data serve an important role in filling this type of scientific knowledge gap and also allow for understanding drivers of treatment choices in usual care. In this retrospective cohort study using Medicare data we propose to achieve 2 aims. In Aim 1, we will characterize patterns of and factors associated with DMRADs and other prescription medication use among older adults with a new diagnosis of LORA. And in Aim 2 we will compare outcomes related to treatment and timing of DMARD-initiation for new cases of LORA. This proposal provides a real-world and population-level study of the care received by older RA patients treated with DMARDs. Preliminary data and analyses obtained from this study will form the basis of future career development awards to address unique challenges related to prescribing high risk medications for older adults. Support from the GEMSSTAR award, mentorship, and training will be invaluable as I progress towards a career as an independent researcher focused on the design, implementation and evaluation of care models to improve quality of care in older patients with rheumatic diseases.

项目概要/摘要类风湿性关节炎 (RA) 是一种慢性、使人衰弱且代价高昂的疾病，对老年人的影响尤为严重。疾病修饰抗风湿药 (DMARD) 可改善 RA 的预后，近年来，治疗方法范式已经发展到促进 DMARD 的早期启动、升级和组合。然而，老年人由于多重用药和多重发病问题，不太可能接受积极治疗。老年人晚发性 RA (LORA) 的疾病活动度更高、影像学进展更多、病情进展更严重功能衰退。因此，不太积极的治疗引起了对较差结果和更大风险的更大担忧。患有 LORA 的老年人的残疾程度。除了实现疾病缓解外，控制疼痛也是一个重要因素治疗 RA 和处方药（包括 NSAIDS、糖皮质激素和阿片类药物在 RA 患者中普遍使用。然而，这些处方药通常是由于相关的副作用，例如跌倒风险，被认为不适合老年人使用，骨折和骨质疏松症。此外，老年人对常见不良反应的耐受性更为有限。药物治疗，并且更容易出现多重用药的累加甚至倍增风险，从而进一步复杂化患有 RA 的病情复杂的老年人的护理。有关使用 DMARD 进行 LORA 新诊断的信息，并且潜在无意依赖其他处方药使用的情况很少见，因为老年人经常被排除在随机对照试验之外。这使得我们在理解如何面对多药治疗和多发病、治疗模式的变化会影响病情复杂的老年人的结果患有 RA 的成人。在缺乏试验数据的情况下，利用行政数据的大型观察性研究可以发挥作用在填补此类科学知识空白方面发挥着重要作用，并且还可以理解驱动因素常规护理中的治疗选择。在这项使用医疗保险数据的回顾性队列研究中，我们建议实现 2 目标。在目标 1 中，我们将描述 DMRAD 和其他处方的模式和相关因素新诊断为 LORA 的老年人的药物使用情况。在目标 2 中，我们将比较结果与新的 LORA 病例的治疗和 DMARD 启动时间相关。该提案提供了一个现实世界以及接受 DMARD 治疗的老年 RA 患者接受护理的人群水平研究。初步数据和从这项研究中获得的分析将构成未来职业发展奖项的基础，以解决独特的问题与为老年人开高风险药物相关的挑战。来自GEMSSTAR奖的支持，当我成为一名专注于独立研究人员的职业生涯时，指导和培训将是非常宝贵的旨在提高老年患者护理质量的护理模式的设计、实施和评估风湿性疾病。