Identifying Patient Subgroups That Are Most Likely To Benefit From Medications Used To Treat Alcohol Use Disorder

项目总结/摘要 这个K 01奖的目的是提供博士约书亚瓦拉赫，流行病学助理教授，在 耶鲁大学公共卫生学院，有必要成为独立专家的保护时间， 综合，评估和建立最佳证据，为酒精使用领域的临床实践提供信息 疾病（AUD）。虽然AUD是一种常见的病态疾病，可以进行药物治疗， 治疗是否有效以及对谁有效的不确定性可能导致AUD药物利用不足。 为了推进支持AUD药物治疗的证据基础，需要进行研究以识别患者 最有可能从用于治疗AUD的每种药物中获益的亚组。但传统 亚组分析通常一次只考虑一种患者特征， 排除标准严格、持续时间短、结局可能无法反映患者感受或 功能拟定的K 01将通过使用多个 数据来源、结果和分析技术。在目标1中，Wallach博士将确定和评估以下内容的有效性： 已发表的亚组分析，以确定最有可能受益的有希望的患者亚组 用于治疗AUD的每种药物。在Aim 2中，来自美国最大的AUD试验（ 联合收割机研究）将用于（a）证实目标1中确定的有希望的患者亚组差异， (b)使用多种方法（即传统方法和统计方法）探索患者亚组之间的新差异 学习，可以考虑多种特征）和结果测量（禁欲，大量饮酒， 2-世界卫生组织饮酒水平的变化）。在目标3中，来自OptumLabs的索赔数据， 超过1.5亿私人保险和医疗保险优势登记者的数据库，将用于确定 在现实环境中是否观察到患者亚组之间存在相同、相似或新的差异 当考虑到医院和门诊护理结果时。这些目标将澄清 患者和临床医生关于采用AUD药物，这可能会降低公共健康 与AUD相关的负担。为了支持这些目标，Wallach博士的职业发展计划将包括 培训：（1）AUD药物和成瘾药物，（2）可以 用于告知个体化临床决策，和（3）药物流行病学和观察 真实世界医疗产品评价的研究方法。候选人已确定跨学科 导师和顾问团队，包括联合主要导师、卫生服务研究员Joseph Ross博士 和行政数据专家，斯蒂芬妮奥马利博士，澳元治疗和成瘾医学专家。 耶鲁大学公共卫生和医学院为职业发展提供了理想的环境。这 K 01将为Wallach博士的R 01提交做准备，并将促进他的长期目标， 创新研究计划结合元研究和现实世界的评估，以改善AUD临床护理。

PROJECT SUMMARY/ABSTRACT The objective of this K01 award is to provide Dr. Joshua Wallach, an Assistant Professor of Epidemiology at the Yale School of Public Health, with the protected time necessary to become an independent expert in synthesizing, evaluating, and establishing the best evidence to inform clinical practice in the field of alcohol use disorder (AUD). Although AUD is a common and morbid disease, for which medication treatment is available, uncertainties about whether and for whom treatments work may be causing AUD medication underutilization. To advance the evidence base to support AUD medication treatment, research is needed to identify patient subgroups that are most likely to benefit from each medication used to treat AUD. However, traditional subgroup analyses often consider only one patient characteristic at a time and are conducted in small clinical trials with strict exclusion criteria, short durations, and outcomes that may not reflect how patients feel or function. This proposed K01 will address these limitations by conducting subgroup analyses using multiple data sources, outcomes, and analytical techniques. In Aim 1, Dr. Wallach will identify and assess the validity of already published subgroup analyses to establish promising patient subgroups that are most likely to benefit from each medication used to treat AUD. In Aim 2, existing data from the largest AUD trial in the US (the COMBINE study) will be used to (a) corroborate promising patient subgroup differences identified in Aim 1 and (b) explore new differences between patient subgroups, using multiple methods (i.e. traditional and statistical learning, which can consider multiple characteristics) and outcome measures (abstinence, heavy drinking, and 2-shift reduction in World Health Organization drinking levels). In Aim 3, claims data from OptumLabs, a database of over 150 million privately insured and Medicare Advantage enrollees, will be used to determine whether the same, similar, or new differences between patient subgroups are observed in real-world settings when hospital and ambulatory care outcomes are considered. These aims will clarify uncertainties among patients and clinicians regarding the adoption of AUD medications, which can decrease the public health burden associated with AUD. To support these aims, Dr. Wallach’s career development plan will include training in: (1) AUD medications and addiction medicine, (2) novel statistical learning techniques that can be used to inform individualized clinical decision making, and (3) pharmacoepidemiology and observational research methods for real-world medical product evaluation. The candidate has identified an interdisciplinary team of mentors and advisors, including co-primary mentors Dr. Joseph Ross, a health services researcher and administrative data expert, and Dr. Stephanie O’Malley, an AUD treatment and addiction medicine expert. The Yale Schools of Public Health and Medicine provide the ideal environment for career development. This K01 will prepare Dr. Wallach for an R01 submission, and will facilitate his long-term goal of developing an innovative research program combining meta-research and real-world evaluation to improve AUD clinical care.