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

• 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
• 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' 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

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.

建议总结