One of the winners of our Student Award is Dr Kim Lauper, a rheumatologist from Geneva, Switzerland. Dr Lauper is a clinical research fellow at the Centre for Epidemiology Versus Arthritis at the University of Manchester. Studying for her PhD, her research focuses on the evaluation of the real-life use of biologic treatments.
Tell us more about the abstract you submitted?
My work for my PhD involves observational studies and I mostly use registers, like BSR’s. From previous studies we see that rheumatoid arthritis patients on tocilizumab may have more infections than with other biologics. However, these patients are often older, have had the disease for longer and more previous treatments, so it’s difficult to compare them to patients with other treatments.
We don’t know if the increase in infections is due to the drug or confounding factors associated with the population. The aim of my study is to evaluate if and how the risk of serious infection on tocilizumab differs when stratifying by line of therapy (number of previous treatments) in a real-world population.
What are the results of your study?
Using data from BSRBR-RA, I looked at the incidence of infections by biologics comparing tocilizumab, TNF-inhibitors and abatacept. When we controlled for usual confounding factors such as age and length of disease, the risk of infections with tocilizumab, adalimumab and infliximab was higher than for etanercept. However, when additionally stratifying by line of therapy the risk was no longer significantly different.
We’ve concluded that it may be a confounding factor that patients have had more previous treatment. This means that maybe the increased risk of infections seen in some studies with drugs usually given to patients with several previous treatment failures may not be linked to the drugs themselves, but some other patient factors.
Why is this an area of interest to you?
Observational data is important because it represents the patients we see every day. Usually observational cohorts are larger, and follow-up is longer than in trials, which is helpful when looking at rare events such as serious infections.
However, observational studies are more prone to bias and confounding, which is why research on methodology is of major interest. We have seen these days that when research with lower quality standards is published, it can really lead to poor clinical decision and undermine the public’s trust in science.
How does winning this award make you feel?
I’m used to working independently as a clinician and going back to being a student means I’ve had to learn all over again. This award validates my research and makes all the hard work worthwhile. I’m a bit older than your typical PhD student, so the win was unexpected. I’m really pleased, and my family and colleagues are thrilled for me too.
What impact will this award have?
It gives a wider platform to the research and what can be achieved with observational studies but also how careful we should be when making conclusions with these kinds of data. It’s a good thing to bring focus to our work and it will hopefully help us to collaborate with others.
What are your next steps?
Our research took data from every patient as far back as 20 years. What we want to do now is some sensitivity analyses such as look at patients since 2009 only, when tocilizumab was first prescribed, and also evaluate specific outcomes, such as particular infections.
In terms of my career, I’d like to progress in my research and become an independent researcher. Once I finish my PhD, I’d like to be able to balance my clinical and research work in Switzerland. Because of my interest in clinical research, I feel it’s very important to still see and treat patients to enable me to develop interesting questions I can answer through research.
Read more about our other award winners: Melissa Sweeney, Melissa Tordoff