I am a Rheumatologist and Postdoctoral Fellow in the Division of Pharmacoepidemiology and Pharmacoeconomics and the Division of Rheumatology, Immunology and Allergy at Brigham and Women's Hospital (BWH), undertaking a training in Pharmacoepidemiology in the rheumatic diseases under the guidance of Drs. Daniel H. Solomon and Sebastian Schneeweiss. My long term goal is to establish a career as an independent pharmacoepidemiology researcher with expertise in the safety of drugs used in the rheumatic diseases. Previous studies have suggested that women with immunocompromised conditions including systemic lupus erythematosus, systemic sclerosis and ulcerative colitis are at a greater risk for cervical dysplasia and human papillomavirus (HPV) infection than are women in the general population. However, scant data exist regarding the risk of cervical dysplasia and HPV infection in rheumatoid arthritis (RA). I propose to use several integrative approaches to evaluate the risk of cervical dysplasia, cervical cancer and HPV infection in patients with RA, to relate the risks of these outcomes to different types of immunosuppressive therapy (i.e., traditional disease-modifying anti-rheumatic drugs versus biologic therapy) as well as demographic and other clinical factors and to examine adherence to current cervical cancer screening guidelines in patients with RA. I will be using different data sources including electronic medical records, large administrative databases, patient survey, as well as patient registries. With the advent of the cervical cancer vaccine, identification of women at high risk carries great public health relevance. The proposed research offers a better understanding of the risk of HPV infection, cervical dysplasia, and cervical cancer in RA patients on immunosuppressive treatments. In addition, it emphasizes the importance of routine surveillance of cervical cancer, which could lead to improvement in the surveillance and management of this potentially fatal, but preventable disease. Both Divisions of Pharmacoepidemiology and Rheumatology at BWH are the ideal environments to pursue my research aims and long term career goal. The Pharmacoepidemiology Division is internationally known as a center of excellence in pharmacoepidemiology research and facilitates a wide range of activities related to the use and outcomes of medications, addressed from a variety of interdisciplinary perspectives. The Rheumatology Division provides excellent clinical care to over 30,000 patients a year and has a large prospective registry of RA patients. The Section of Clinical Sciences in the Rheumatology Division, under the direction of Dr. Solomon, is renowned for excellence in clinical investigation with a focus on RA research. Both Divisions have valuable resources including space, equipment, and knowledgeable faculty including experts in RA research as well as pharmacoepidemiology to help me achieve my goals.

Public Health Relevance

Although both cervical dysplasia and HPV infection are very common, the risks of these conditions in patients with RA, particularly those treated with immunosuppressive drugs is unknown. This proposal will lead to more informed management and surveillance of patients with RA for potentially life-threatening, but largely vaccine- preventable cervical cancer.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AR059677-03
Application #
8307483
Study Section
Special Emphasis Panel (ZAR1-CHW (M3))
Program Officer
Witter, James
Project Start
2010-08-01
Project End
2015-07-31
Budget Start
2012-08-01
Budget End
2013-07-31
Support Year
3
Fiscal Year
2012
Total Cost
$135,726
Indirect Cost
$10,054
Name
Brigham and Women's Hospital
Department
Type
DUNS #
030811269
City
Boston
State
MA
Country
United States
Zip Code
02115
Kim, Seoyoung C; Schneeweiss, Sebastian; Liu, Jun et al. (2016) Biologic Disease-Modifying Antirheumatic Drugs and Risk of High-Grade Cervical Dysplasia and Cervical Cancer in Rheumatoid Arthritis: A Cohort Study. Arthritis Rheumatol 68:2106-13
Kim, Seoyoung C; Choi, Nam-Kyong; Lee, Joongyub et al. (2016) Brief Report: Utilization of the First Biosimilar Infliximab Since Its Approval in South Korea. Arthritis Rheumatol 68:1076-9
Feldman, C H; Liu, J; Feldman, S et al. (2016) Risk of high-grade cervical dysplasia and cervical cancer in women with systemic lupus erythematosus receiving immunosuppressive drugs. Lupus :
Kim, Seoyoung C; Paik, Julie M; Liu, Jun et al. (2016) Gout and the Risk of Non-vertebral Fracture. J Bone Miner Res :
Kim, Seoyoung C; Liu, Jun; Solomon, Daniel H (2016) Risk of incident atrial fibrillation in gout: a cohort study. Ann Rheum Dis 75:1473-8
MacFarlane, Lindsey A; Liu, Chih-Chin; Solomon, Daniel H et al. (2016) Validation of claims-based algorithms for gout flares. Pharmacoepidemiol Drug Saf 25:820-6
Desai, Rishi J; Solomon, Daniel H; Shadick, Nancy et al. (2016) Identification of smoking using Medicare data--a validation study of claims-based algorithms. Pharmacoepidemiol Drug Saf 25:472-5
Desai, Rishi J; Solomon, Daniel H; Schneeweiss, Sebastian et al. (2016) Tumor Necrosis Factor-α Inhibitor Use and the Risk of Incident Hypertension in Patients with Rheumatoid Arthritis. Epidemiology 27:414-22
Solomon, Daniel H; Liu, Chih-Chin; Kuo, I-Hsin et al. (2016) Effects of colchicine on risk of cardiovascular events and mortality among patients with gout: a cohort study using electronic medical records linked with Medicare claims. Ann Rheum Dis 75:1674-9
Desai, Rishi J; Huybrechts, Krista F; Bateman, Brian T et al. (2016) Brief Report: Patterns and Secular Trends in Use of Immunomodulatory Agents During Pregnancy in Women With Rheumatic Conditions. Arthritis Rheumatol 68:1183-9

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