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

建议书摘要 许多患有自身免疫性疾病的老年人使用生物抗炎疗法(生物制剂)进行治疗 控制他们的症状，减缓疾病的进展。虽然使用阿片类药物治疗慢性和神经性疾病 疼痛仍然存在争议，尽管如此，它们仍可能被普遍开给患有自身免疫性疾病的老年人。 疾病与生物制品并存。阿片类药物也最常开给老年人，他们经历了 由于衰老相关的变化，炎症、疼痛和自身免疫性疾病的患病率高得惊人 就像免疫衰老一样。阿片类药物对免疫系统的影响仍然知之甚少，它们可能 与生物制品一起诱导免疫抑制，导致不良事件的风险增加，如严重 感染，通过药效学药物-药物相互作用。尽管慢性炎症和慢性炎症重合 自身免疫性疾病中的疼痛，阿片类药物和生物制剂同时使用的安全性结果尚未得到证实 评估过了。因此，处方医生没有足够的关于同时使用阿片和类阿片的安全性的信息。 生物制品，并继续这种做法，可能对他们的患者有害。这是对大样本的评估 2007至2019年间，超过300万患有自身免疫性疾病的老年人参加了联邦医疗保险， 关于同时使用阿片类药物和生物制品的新安全见解，改善个人治疗结果 患有自身免疫性疾病。这项提议的长期目标是维护老年人的健康和福祉 通过优化成人自身免疫性疾病的治疗策略。为了实现这一目标，我们将 确定阿片类药物使用、生物使用以及同时使用阿片类药物和生物药物的模式和预测因素 老年人中的一系列自身免疫性疾病(目标1)，评估阿片类药物使用对依从性的影响 在患有自身免疫性疾病的老年人中使用生物制剂(AIM 2)，并检查阿片类药物对安全性的影响 使用生物疗法的老年自身免疫性疾病患者的结局(目标3)。这些建议 研究将由首席调查员完成，并由深度研究的合作者提供支持和指导 在高级药物流行病学方法和阿片类药物和生物制品研究方面的专业知识。校长 调查员得到了协作和跨学科研究环境的支持，该环境包括世界 布朗大学著名的老年学和卫生保健研究中心和流行病学系 大学公共卫生学院。本申请中详细介绍的培训活动侧重于推进 定量计算技能和发展药物流行病学的深入背景知识，威尔 让首席调查员为独立流行病学家的职业生涯做好准备。

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.