Treating pain in autoimmune disease: concurrent use of opioids and biologic medication

治疗自身免疫性疾病的疼痛：同时使用阿片类药物和生物药物

基本信息

批准号：
10607303
负责人：
Meghan Cupp Buxton
金额：
$ 4.77万
依托单位：
BROWN UNIVERSITY
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：
2023-06-01 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10607303
关键词：
Address Adherence Adverse event Affect Age Aging Anti-Inflammatory Agents Antibiotics Autoimmune Diseases Biological Biological Products Biological Response Modifier Therapy Chronic Crohn&apos s disease Data Analyses Dependence Development Diagnosis Disease Disease Management Disease Outcome Disease Progression Drug Combinations Drug Interactions Elderly Enrollment Environment Epidemiologist Epidemiology Exclusion Female Gerontology Goals Health Health Care Research High Prevalence Hospitalization Immune system Immunosuppression Individual Infection Inflammation Interdisciplinary Study Knowledge Literature Lupus Medicare Medicine Mentorship Methodology Methods Multiple Sclerosis National Institute on Aging Opioid Outcome Pain Pain management Patient-Focused Outcomes Patients Pattern Personal Satisfaction Pharmaceutical Preparations Pharmacodynamics Pharmacoepidemiology Population Prevalence Principal Investigator Public Health Schools Research Research Personnel Research Proposals Rheumatoid Arthritis Rheumatology Safety Sampling Services Symptoms Testing Time Training Training Activity Treatment outcome Ulcerative Colitis United States Universities Woman Work adverse event risk age related biological research career chronic pain management clinical practice disability effective intervention experience immunosenescence improved innovation insight mortality novel opioid use painful neuropathy prescription opioid prevent safety assessment safety outcomes skills treatment optimization treatment strategy

Address Adherence Adverse event Affect Age Aging Anti-Inflammatory Agents Antibiotics Autoimmune Diseases Biological Biological Products Biological Response Modifier Therapy Chronic Crohn&apos s disease Data Analyses Dependence Development Diagnosis Disease Disease Management Disease Outcome Disease Progression Drug Combinations Drug Interactions Elderly Enrollment Environment Epidemiologist Epidemiology Exclusion Female Gerontology Goals Health Health Care Research High Prevalence Hospitalization Immune system Immunosuppression Individual Infection Inflammation Interdisciplinary Study Knowledge Literature Lupus Medicare Medicine Mentorship Methodology Methods Multiple Sclerosis National Institute on Aging Opioid Outcome Pain Pain management Patient-Focused Outcomes Patients Pattern Personal Satisfaction Pharmaceutical Preparations Pharmacodynamics Pharmacoepidemiology Population Prevalence Principal Investigator Public Health Schools Research Research Personnel Research Proposals Rheumatoid Arthritis Rheumatology Safety Sampling Services Symptoms Testing Time Training Training Activity Treatment outcome Ulcerative Colitis United States Universities Woman Work adverse event risk age related biological research career chronic pain management clinical practice disability effective intervention experience immunosenescence improved innovation insight mortality novel opioid use painful neuropathy prescription opioid prevent safety assessment safety outcomes skills treatment optimization treatment strategy

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项目摘要

PROPOSAL SUMMARY Many older adults with autoimmune disease are treated with biologic anti-inflammatory therapies (biologics) to control their symptoms and slow disease progression. Although using opioids to treat chronic and neuropathic pain remains controversial, they may nonetheless be commonly prescribed to older adults with autoimmune diseases alongside biologics. Opioids are also most often prescribed to older adults, who experience an inordinately high prevalence of inflammation, pain, and autoimmune conditions due to aging-associated changes like immunosenescence. The effects of opioids on the immune system remain poorly understood and they may induce immunosuppression alongside biologics, leading to increased risk of adverse events, such as severe infection, through pharmacodynamic drug-drug interaction. Despite the coincidence of chronic inflammation and pain in autoimmune disease, the safety outcomes from concurrent opioid and biologic use have not been assessed. Therefore, prescribers do not have enough information on the safety of concurrent use of opioids and biologics, and continue this practice, possibly to their patients’ detriment. This assessment of large sample of over 3 million older adults enrolled in Medicare between 2007 and 2019 with autoimmune disease will produce novel safety insights on the concurrent use of opioids and biologics, improving treatment outcomes for individuals with autoimmune diseases. The long term goal of this proposal is to maintain the health and well-being of older adults with autoimmune diseases through the optimization of treatment strategies. In service of this goal, we will Determine the patterns and predictors of opioid use, biologic use, and concurrent opioid and biologic use across an array of autoimmune diseases among older adults (AIM 1), assess the effects of opioid use on adherence to biologics among older adults with autoimmune diseases (AIM 2), and examine the effects of opioids on safety outcomes among older adults with autoimmune diseases using biologic therapies (AIM 3). These proposed studies will be completed by the principal investigator with support and mentorship from collaborators with deep expertise in advanced pharmacoepidemiology methods and opioid and biologics research. The principal investigator is supported by a collaborative and interdisciplinary research environment that includes the world renowned Center for Gerontology and Health Care Research and Department of Epidemiology at the Brown University School of Public Health. The training activities detailed in this application, focused on advancing quantitative computational skills and developing a deep contextual knowledge of pharmacoepidemiology, will prepare the principal investigator for a career as an independent epidemiologist.

提案摘要许多患有自身免疫性疾病的老年人接受了生物抗炎疗法（生物制剂）治疗控制其症状并缓慢疾病进展。虽然使用阿片类药物治疗慢性和神经性疗法疼痛仍然有争议，尽管如此，它们通常会开发给自身免疫的老年人与生物制剂一起疾病。阿片类药物也经常向老年人开处方，他们经历了由于衰老相关的变化，炎症，疼痛和自身免疫性状况的高度高。像免疫衰老一样。卵毒素对免疫系统的影响仍然很少了解，它们可能与生物制剂一起诱导免疫抑制，导致不良事件的风险增加，例如严重感染，通过药物药物相互作用。尽管慢性感染和自身免疫性疾病的疼痛，同时使用的阿片类药物和生物使用的安全结果尚未评估。因此，处方者没有足够的信息有关同时使用阿片类药物的安全性信息生物制剂并继续这种做法，可能会损害患者。大量样本的评估在2007年至2019年间，超过300万年级的Medicare患有自身免疫性疾病的老年人将产生关于同时使用阿片类药物和生物制剂的新型安全见解，改善了个体的治疗结果患有自身免疫性疾病。该提议的长期目标是维持老年人的健康和福祉通过优化治疗策略的自身免疫性疾病的成年人。为了实现这个目标，我们将确定使用，生物使用，生物使用以及并发蛋白和生物学的模式和预测因素老年人中的一系列自身免疫性疾病（AIM 1）评估使用阿片类药物对依从性的影响自身免疫性疾病的老年人的生物制剂（AIM 2），并检查阿片类药物对安全性的影响使用生物学疗法的自身免疫性疾病的老年人的结果（AIM 3）。这些提议首席研究员将完成研究，并获得深刻合作者的支持和指导。高级药物养育方法和阿片类药物和生物学研究方面的专业知识。校长研究人员得到了包括世界在内的合作和跨学科研究环境的支持著名的老年医学与医疗保健研究中心和布朗的流行病学系大学公共卫生学院。本应用程序中详细介绍的培训活动，专注于前进定量计算技能和发展药物ePidemiology的深刻上下文知识，将为主要的研究人员做好准备，成为独立流行病学家的职业。