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, Cuyahoga County’s public health system, is honoring its commitment to create a healthier community by building a new hospital on its main campus in Cleveland. The building and the 25 acres of green space around it are catalyzing the revitalization of MetroHealth’s West Side neighborhood.
MetroHealth broke ground on its new hospital in 2019. The project is being financed with nearly $1 billion the system borrowed on its own credit after dramatically improving its finances. In the past five years, MetroHealth’s operating revenue has increased by 40% and its number of employees by 21%. Today, its staff of 8,000 provides care at MetroHealth’s four hospitals, four emergency departments and more than 20 health centers and 40 additional sites throughout Cuyahoga County. In the past year, MetroHealth has served 300,000 patients at more than 1.4 million visits in its hospitals and health centers, 75% of whom are uninsured or covered by Medicare or Medicaid.
The health system 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 teaching and research. Each active staff physician holds a faculty appointment at Case Western Reserve University School of Medicine. Its main campus hospital houses a Cleveland Metropolitan School District high school of science and health.
For more information, visit metrohealth.org.
About Case Western Reserve University
Case Western Reserve University is one of the country's leading private research institutions. Located in Cleveland, we offer a unique combination of forward-thinking educational opportunities in an inspiring cultural setting. Our leading-edge faculty engage in teaching and research in a collaborative, hands-on environment. Our nationally recognized programs include arts and sciences, dental medicine, engineering, law, management, medicine, nursing and social work. About 5,100 undergraduate and 6,700 graduate students comprise our student body. Visit case.edu to see how Case Western Reserve thinks beyond the possible.