A Personalized, Patient-Centered Approach to Optimizing Lupus Care

候选人：April Jorge，医学博士是哈佛医学院（HMS）的医学讲师， 在马萨诸塞州总医院（MGH）的流变学部门的医学。毕业后 马里兰州大学以优异成绩毕业，她在乔治敦大学获得医学博士学位， 完成了她在西北大学的内科住院医师实习。她完成了风湿病学 在此期间，她还完成了哈佛催化剂临床和转化研究 学院，并开始与Hyon Choi，MD，DrPH。乔治博士之前的工作已经导致了15个同行- 评审的原创论文，其中13篇为第一作者或共同第一作者。她的目标是成为一个独立的 系统性红斑狼疮（SLE）患者导向研究的研究者和创新领导者。 导师，培训活动和环境：豪尔赫博士将在MGH进行拟议的项目 在Hyon Choi，MD，DrPH和Karen Costenbader，MD，MPH和Karen的共同指导下， Sepucha博士崔博士是一位世界知名的，NIH资助的高级临床流行病学医生科学家 风湿性疾病，从常见疾病到罕见但严重的疾病（例如，SLE）。他 曾担任过几位K奖得主的导师。Costenbader博士是SLE的临床研究者和专家 他也是K奖获得者的经验丰富的导师。Sepucha博士是以患者为中心的 决策科学豪尔赫博士的研究也将受益于她的主要合作者的具体专业知识， 包括先进的临床流行病学方法、机器学习预测算法和决策- 解析建模除了接受优秀的指导，她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， 混合方法研究方法和决策分析建模。 研究：SLE携带多种合并症的风险增加，死亡风险增加一倍， 一般人口。目前的治疗方法部分受限于几种经过验证的药物和不良反应 方面的影响.本研究的中心目标是通过整合个性化治疗， 潜在危害和受益的风险与患者偏好，以指导个性化、以患者为中心的使用 狼疮的主要药物为了实现这一目标，她将冒险对患者进行分层，以了解治疗的潜在危害， 也就是说，与其他免疫抑制剂相比，贝利木单抗治疗羟氯喹视网膜病变和感染，以及 其他不良后果，即，严重COVID-19感染（目标1）。她会引出病人对SLE的偏好 通过离散选择实验（目标2a）进行治疗，并将患者偏好与 通过多标准决策分析确定最佳羟氯喹剂量的个性化风险 SLE护理（目标2b）。完成本建议书和培训计划将使Jorge博士成为 经验，成为一个独立的临床研究者在病人为导向的研究系统性红斑狼疮。

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.