A Personalized, Patient-Centered Approach to Optimizing Lupus Care

候选人：阿普丽尔·豪尔赫，医学博士，哈佛医学院(HMS)医学讲师， 麻省总医院(MGH)风湿科的内科医生。从大学毕业后 马里兰大学以优异成绩毕业于乔治城大学，获得医学博士学位 完成了她在西北大学的内科实习。她完成了风湿病的治疗 在麻省理工学院获得奖学金，在此期间她还完成了哈佛大学的临床和转化催化剂研究 并开始与Hyon Choi，医学博士，博士合作。豪尔赫博士之前的工作已经导致了15个同龄人- 审阅原始论文，其中13篇为第一作者或共同第一作者。她的目标是成为一名独立人士。 以患者为中心的系统性红斑狼疮(SLE)研究的研究者和创新领导者。 指导、培训活动和环境：豪尔赫博士将在麻省理工学院领导拟议的项目 在Hyon Choi，MD，DrPH的指导下，以及Karen Cotenbader，MD，公共卫生硕士和Karen的共同指导下 Sepucha博士。崔博士是美国国立卫生研究院资助的世界知名的高级临床流行病学内科科学家。 风湿性疾病，从常见疾病到罕见但严重的疾病(如系统性红斑狼疮)。他有 曾担任过几位前K奖获得者的导师。科斯滕巴德博士是系统性红斑狼疮的临床研究员和专家。 他也是K奖获得者的经验丰富的导师。赛普查博士是以患者为中心的一流专家 决策科学。豪尔赫博士的研究还将受益于她的主要合作者的特定专业知识， 包括先进的临床流行病学方法、机器学习预测算法和决策- 分析建模。除了得到良好的指导外，她还将通过教学获得新的技能 高级临床流行病学和药物流行病学、风险预测、吸引患者偏好 混合方法研究方法，决策分析建模。 研究：系统性红斑狼疮患多种并发症的风险增加，死亡风险比 普通人口。目前的治疗在一定程度上受到少数经过验证的药物和不良治疗的限制 效果。这项研究的中心目标是通过整合个性化的SLE来改善长期SLE结果 患者偏好的潜在危害和好处的风险，以指导个性化、以患者为中心的使用 关键的狼疮药物。为了实现这一目标，她将冒险对患者进行分层治疗， 即羟基氯喹视网膜病变和使用belimumab与其他免疫抑制剂相比的感染，以及 其他不良后果，即严重新冠肺炎感染(目标1)。她将引起患者对SLE的偏好 通过离散选择实验进行治疗(目标2a)，并将患者的偏好与 通过多准则决策分析确定最佳羟氯喹剂量的个性化风险 在系统性红斑狼疮护理中(目标2b)。完成这项提案和培训计划将使豪尔赫博士成为至关重要的 在以患者为中心的系统性红斑狼疮研究中成为独立的临床研究员的经验。

Candidate: April Jorge, MD is an Instructor in Medicine at Harvard Medical School (HMS) and an Assistant in Medicine in the Rheumatology Unit at Massachusetts General Hospital (MGH). After graduating from the University of Maryland magna cum laude, she received her MD from Georgetown University, and she completed her internal medicine residency at Northwestern University. She completed her rheumatology fellowship at MGH, during which she also completed the Harvard Catalyst Clinical and Translational Research Academy and began working with Hyon Choi, MD, DrPH. Dr. Jorge's prior work has resulted in 15 peer- reviewed original papers, with 13 as the first author or co-first author. Her goal is to become an independent investigator and innovative leader in patient-oriented research of systemic lupus erythematosus (SLE). Mentorship, Training Activities, and Environment: Dr. Jorge will conduct the proposed project at MGH under the mentorship of Hyon Choi, MD, DrPH and co-mentorship of Karen Costenbader, MD, MPH and Karen Sepucha, PhD. Dr. Choi is a world-renowned, NIH-funded physician scientist in advanced clinical epidemiology of rheumatic conditions, ranging from common disorders to rare but serious disorders (e.g., SLE). He has served as a mentor for several prior K awardees. Dr. Costenbader is a clinical investigator and expert in SLE who is also an experienced mentor of K awardees. Dr. Sepucha is a leading expert in patient-centered decision science. Dr. Jorge's research will also benefit from the specific expertise of her key collaborators, including advanced clinical epidemiology methods, machine learning prediction algorithms, and decision- analytic modeling. In addition to receiving excellent mentorship, she will acquire new skills through didactics in advanced clinical epidemiology and pharmacoepidemiology, risk prediction, eliciting patient preferences with a mixed methods research approach, and decision-analytic modeling. Research: SLE carries increased risks of multiple comorbidities and double the risk of death compared to the general population. Current treatment is limited in part by few proven medications and adverse treatment effects. The central goal of this research is to improve long-term SLE outcomes by integrating personalized risks of potential harms and benefits with patient preferences to guide the personalized, patient-centered use of key lupus medications. To achieve this goal, she will risk stratify patients for potential harms of treatment, i.e., hydroxychloroquine retinopathy and infection with belimumab use versus other immunosuppressants, and other adverse outcomes, i.e., severe COVID-19 infection (Aim 1). She will elicit patient preferences for SLE treatment through a discrete choice experiment (Aim 2a) and will integrate patient preferences with personalized risks through a multi-criteria decision analysis to determine the optimal hydroxychloroquine dose in SLE care (Aim 2b). Completion of this proposal and training plan will position Dr. Jorge with the vital experience to become an independent clinical investigator in patient-oriented research of SLE.