Understanding disease modifying antirheumatic drug use in older adults with late-onset rheumatoid arthritis

项目总结/摘要 风湿性关节炎（RA）是一种慢性、使人衰弱的炎症性疾病， 美方患有类风湿性关节炎的老年人数量正在增加，三分之一被诊断为迟发性类风湿性关节炎 （LORA），其特征是更严重的疾病，诊断时更大的合并症负担和残疾。 患有RA的老年人不太可能接受有效的疾病缓解抗风湿药物（DMARD）， 更有可能接受长期糖皮质激素单独治疗，这表明我们可能接受较少 比在这个人群中进行最佳管理和更好的结果可能是可以实现的。Jiha Lee博士是一位 密歇根大学的助理教授，他的长期目标是成为一名独立的 老年风湿病学的研究者和国家领导人专注于推进有效的 药物使用，以改善老年人风湿性疾病的护理。K23患者的治疗- 定向研究职业发展奖申请（PA-20-205）将支持李博士获得额外的 培训和指导，并通过完成拟议的工作，成为少数临床科学家之一， 在风湿病学，衰老，药物流行病学和混合方法的交叉点的独特资格 研究在风湿病学领域进行严格的老化研究。这项研究的首要科学目标是 指导性研究建议是调查次优DMARD使用和对不同治疗的耐受性 在LORA老年人的常规护理中使用治疗方案，并让患者和提供者更好地 了解观察到的结果。拟议的解释性顺序混合方法研究将在全国范围内使用 目标1和目标2的代表性医疗保险索赔数据，然后进行深入的半结构化访谈， 目标3的患者和供应商。具体而言，在目标1中，Lee博士将检查患者和提供者/医疗保健 与LORA老年患者在治疗后的前12个月内使用次优DMARD相关的因素 诊断索引日期，收集关键信息，以确定未来改善DMARD工作的目标 使用.为了建立更多的循证处方，在目标2中，她将检查与以下因素相关的结果： 不同的治疗方案，并确定最有可能出现不良结局的患者。在目标3中，她将使用 目标1和2的结果指导采样策略，讨论指导患者参与的开发 与LORA和提供者一起检查并告知推动治疗的其他潜在重要因素 接近。李博士将在密歇根大学丰富的环境中进行所有工作， 由朱莉·拜纳姆博士领导的导师和顾问团队。拟议的工作将奠定 为识别存在不良结局风险的亚群并为R 01级建立证据基础奠定基础 应用，以告知开发和评估适合年龄的LORA治疗方法。

PROJECT SUMMARY/ABSTRACT Rheumatoid arthritis (RA) is a chronic, debilitating inflammatory disease that affects 1.3 million older adults in the US. The number of older adults living with RA is growing and one-third are diagnosed with late-onset RA (LORA), characterized by more severe disease, greater comorbidity burden at time of diagnosis, and disability. Older adults with RA are less likely to receive effective disease modifying antirheumatic drugs (DMARDs) and more likely to receive long-term glucocorticoids alone for treatment which suggest we may be accepting less than optimal management in this population and better outcomes may be achievable. Dr. Jiha Lee is an Assistant Professor at the University of Michigan whose long-term goal is to become an independent investigator and national leader in geriatric rheumatology focused on advancing the science of effective medication use to improve the care of older adults with rheumatic diseases. This K23 Mentored Patient- Oriented Research Career Development Award application (PA-20-205) will support Dr. Lee to gain additional training and mentoring, and by completing the proposed work to become one of the few clinician-scientists with unique qualifications at the intersection of rheumatology, aging, pharmacoepidemiology, and mixed methods research to conduct rigorous aging research in the field of rheumatology. The overarching scientific goal of this mentored-research proposal is to investigate suboptimal DMARD use and tolerability to different treatment regimens in usual care among older adults with LORA and to engage patients and providers to better understand observed outcomes. The proposed explanatory sequential mixed methods study will use nationally representative Medicare claims data for Aims 1 and 2, followed by in-depth semi-structured interviews with patients and providers for Aim 3. Specifically, in Aim 1, Dr. Lee will examine patient and provider/healthcare factors associated with suboptimal DMARD use in older adults with LORA during the first 12 months after index date of diagnosis, gathering critical information to identify targets for future efforts to improve DMARD use. To build toward more evidence-based prescribing, in Aim 2 she will examine outcomes associated with different treatment regimens and identify patients at greatest risk of poor outcomes. In Aim 3, she will use the results from Aims 1 and 2 to guide the sampling strategy and discussion guide development to engage patients with LORA and providers to examine and inform additional potentially important factors that drive treatment approaches. Dr. Lee will conduct all work at the rich environment of the University of Michigan, with guidance from her exceptional team of mentors and advisors led by Dr. Julie Bynum. The proposed work will lay the foundation to identify subpopulations at risk of poor outcomes and build the evidence base for an R01-level application to inform development and evaluation of age-appropriate approaches to treatment of LORA.