Investigating the Risk of Lymphoma in Psoriasis Patients

描述(由申请人提供)： 银屑病是一种常见的慢性免疫介导性疾病。越来越多的证据表明，牛皮癣患者患淋巴增生性恶性肿瘤的风险增加。治疗牛皮癣的不断发展的疗法针对的是免疫系统，因此，这些治疗方法可能会进一步增加牛皮癣患者的淋巴瘤发生率。为了研究牛皮癣患者的淋巴瘤预后，需要对一大批患者进行多年跟踪调查。这项建议将严格调查全科医学研究数据库(GPRD)的有效性，该数据库是英国的一个医疗记录数据库，拥有900万名患者和超过3500万人年的随访，用于对牛皮癣患者进行高质量的人群流行病学研究。这一目标将有助于开发一种极其有用的工具，用于在牛皮癣患者中进行基于人群的研究。然后，我们将在GPRD人群中进行一项大型队列研究，以确定牛皮癣是否与淋巴瘤风险增加有关。这一目标将对监测银屑病患者免疫抑制治疗的安全性具有重要意义。最后，我们将开发更多的方法来评估牛皮癣的皮肤受累程度，以确定这一变量对淋巴瘤和其他结果的影响，用于对牛皮癣的研究。这一目的将为牛皮癣的严重程度分类提供一种经过严格验证的方法，用于未来的各种牛皮癣研究。这项申请的第二个主要目标是为应聘者提供必要的指导和额外培训，使其成为一名独立的调查员。应聘者已经与领先的高级调查人员建立了指导关系，这种关系将通过本申请中计划的研究来培养。候选人还将在流行病学高级研究生课程中接受额外的正规培训，以便使他能够在他以前在硕士级别的流行病学培训中积累的专业知识的基础上再接再厉。通过研究计划、指导计划和本申请中概述的额外课程的结合，候选人将为成为一名专注于改善皮肤病患者生活的独立调查者做好充分准备。

DESCRIPTION (provided by applicant): Psoriasis is a common chronic immune mediated disease. There is increasing evidence demonstrating that psoriasis patients have an increased risk of lymphoproliferative malignancies. The evolving therapies for psoriasis target the immune system and therefore, these treatments may further increase the rate of lymphoma in psoriasis patients. To study lymphoma outcomes in psoriasis patients a large cohort of patients needs to be followed for many years. This proposal will rigorously investigate the validity of the General Practice Research Database (GPRD), a medical record database in the United Kingdom with 9 million patients and over 35 million person years of follow up, for performing high quality population based epidemiology studies in psoriasis patients. This aim will help develop an extremely useful tool for conducting population based studies in psoriasis patients. We will then perform a large cohort study in the GPRD population to determine if psoriasis is associated with an increased risk of lymphoma. This aim will have important implications for monitoring the safety of immunosuppressive therapies in psoriasis patients. Finally, we will develop additional methodologies for assessing the extent of psoriasis skin involvement to determine the impact this variable has on lymphoma and other outcomes for use in studies of psoriasis in the population at large. This aim will provide a rigorously validated method for classifying severity of psoriasis for use in a variety of future psoriasis studies. A second major goal of this application is to provide the mentoring and additional training necessary for the candidate to become an independent investigator. The candidate has established mentoring relationships with leading senior investigators that will be fostered through the studies planned in this application. The candidate will also pursue additional formal training in advanced level graduate courses in epidemiology in order to allow him build upon the foundation of expertise he has built through his previous training in epidemiology at the masters level. Through the combination of the research program, mentoring program, and additional coursework outlined in this application the candidate will be well prepared to be an independent investigator concentrating on improving the lives of patients suffering with dermatologic disease.