Electronic Health Records Used in Study of Drug-Effectiveness to Reduce Risk of Alzheimer’s Disease
CLEVELAND – Researchers have harnessed the power of electronic health records to gain insight in the potential of inflammation-controlling medications to reduce a patient’s Alzheimer’s disease risk.
Rong Xu, PhD, professor of Biomedical Informatics and Director of the Center for Artificial Intelligence in Drug Discovery at Case Western Reserve University; Mark Gurney, PhD, chairman and CEO of Tetra Therapeutics; and David Kaelber, MD, PhD, chief medical informatics officer and vice president of Health Informatics at The MetroHealth System, accessed nearly 20 years of electronic health records (1999 to 2018) from the IBM Watson Healthcare Explorys Cohort Discovery platform. The researchers analyzed the de-identified records from 56 million unique adult patients from 26 health care systems throughout the United States.
The large, retrospective case-control study found that the risk for Alzheimer’s disease in patients being treated with adalimumab (Humira®) for rheumatoid arthritis and in patients treated with etanercept (Enbrel®) or adalimumab for psoriasis was lower than the general population risk. Patients taking adalimumab for psoriasis also showed a decreased risk of dementia.
The findings have been published in the research journal PLOS One.
The researchers wanted to test the hypothesis that systemic inflammation involving tumor necrosis factor (TNF) is associated with an increased risk for Alzheimer’s disease (AD), and that treating patients who had inflammation with a TNF-blocking agent would be effective in reducing a person’s risk for developing AD.
Patients for the study were drawn from the Explorys platform and categorized based on their inflammatory disease diagnoses (including rheumatoid arthritis (RA), psoriasis, inflammatory bowel disease, ulcerative colitis, and Crohn’s disease) and medication history. For the analysis, subjects were included if they were treated with a single TNF blocker, but were excluded if they were diagnosed with more than one disease or treated with two or more TNF-blocking drugs.
The study methodology underscores the immense potential of using big databases, said Dr. Xu. “The cloud-based informatics tools and platforms allow researchers to easily build patient cohorts with specific disease and demographic characteristics,” she said.
Also, the Explorys platform contains a study population that includes patients with private insurance, Medicare, Medicaid, and military insurance. Not only is it particularly critical for the study of diseases that primarily affect an elderly population, since most patients older than 65 in the United States transition from private insurance to Medicare, it is important for the study of diseases that are affected by economic status, Xu said.
Because the study is an associational study, researchers could not decipher the causal relationships between TNF alpha, TNF alpha inhibitors, and AD/dementia based solely on electronic health records. More study is needed using experimental models and animal models.
The study was supported by the National Institute on Aging, a division of the National Institutes of Health.
The MetroHealth System is redefining health care by going beyond medical treatment to improve the foundations of community health and well-being: affordable housing, a cleaner environment, economic opportunity and access to fresh food, convenient transportation, legal help and other services. The system strives to become as good at preventing disease as it is at treating it.
The system’s more than 600 doctors, 1,700 nurses and 7,800 employees go to work each day with a mission of service, to their patients and to the community. As Cuyahoga County’s safety-net health system, MetroHealth plays an essential role in the region, caring for anyone and everyone, regardless of an ability to pay.
Founded in 1837, MetroHealth operates four hospitals, four emergency departments and more than 20 health centers and 40 additional sites throughout Cuyahoga County. The system serves more than 300,000 patients, two-thirds of whom are uninsured or covered by Medicare or Medicaid.
MetroHealth is home to Cuyahoga County’s most experienced Level I Adult Trauma Center, verified since 1992, and Ohio’s only adult and pediatric trauma and burn center.
As an academic medical center, MetroHealth is committed to research and to teaching and training tomorrow’s caregivers. Each active staff physician holds a faculty appointment at Case Western Reserve University School of Medicine. Its main campus hospital houses the Cleveland Metropolitan School District’s Lincoln-West School of Science & Health, the only high school in America located inside a hospital.
Knowing that good health is about much more than good medical care, MetroHealth has launched the Institute for H.O.P.E.™ (Health, Opportunity, Partnership, Empowerment), which uses a coordinated, collaborative and strategic approach to help patients with non-medical needs such as healthy food, stable housing and job training.
The MetroHealth Glick Center, a new 11-floor hospital, is under construction on the system’s main campus in Cleveland and is scheduled to welcome its first patients in October 2022. The billion-dollar project is the cornerstone of a wider neighborhood revitalization effort led by the system and its partners in the community.
For more information, visit metrohealth.org.