Candace Feldman, MD, MPH, ScD
Assistant Professor of Medicine, Harvard Medical School; Associate Physician, Brigham and Women’s Hospital
About the Researcher
Candace Feldman, MD, MPH, ScD is an Assistant Professor of Medicine at Brigham and Women’s Hospital and Harvard Medical School in the Division of Rheumatology, Inflammation and Immunity.
She received her MD from the Yale School of Medicine, her MPH from Johns Hopkins Bloomberg School of Public Health and her ScD in Social and Behavioral Sciences from the Harvard T.H. Chan School of Public Health. She completed both her residency and fellowship at Brigham and Women’s Hospital. Clinically, she is a practicing rheumatologist with a specific focus on the care of patients with lupus as well as patients with complex medical and social needs. Her NIH-funded research focuses on racial, ethnic and socioeconomic health disparities in rheumatic diseases and intervention design to reduce disparities in avoidable outcomes.
Dr. Feldman is the 2019 recipient of the the Lupus Foundation of America's Mary Betty Stevens Young Investigator Prize, and the 2013 recipient of the Career Development Award. She serves on the Editorial Board of Arthritis Care & Research, on the Board of Directors of the American College of Rheumatology, and on the Medical and Scientific Advisory Board of the Lupus Foundation of America.
Meet the Researcher
2013 Career Development Award Project
Title of Project: Comparative Risks of Infections In Lupus Patients on Immunosuppressants
Patients with systemic lupus erythematosus (SLE) and with lupus nephritis (LN) have a significantly heightened risk of serious infections leading to increased hospitalizations and mortality. Both the disease itself and the immunosuppressant medications prescribed likely contribute.
Prior studies comparing risks of infection in patients with moderate-to-severe SLE and LN receiving the most frequently prescribed immunosuppressant medications azathioprine, mycophenolate mofetil, and cyclophosphamide, are limited by small sample sizes and short follow-up.
This study will investigate the burden of serious bacterial, fungal and viral infections requiring hospitalization in a large cohort of more than 24 million Medicaid enrollees from 2000 to 2006. In addition, we will compare SLE and LN patients who received azathioprine vs. mycophenolate mofetil, and myocophenolate mofetil vs. cyclophosphamide to determine which of these medications may confer an increased risk of infection.
To accomplish this, we will utilize a database of Medicaid billing claims for more than 43,000 patients with SLE and nearly 10,000 with LN. We will identify patients who develop serious infections over the 7 years of enrollment and examine differences in rates of bacterial, fungal and viral infections by demographic factors, comorbidities and medications. We will then investigate the comparative risk of serious infections among the approximately 7,000 SLE and 3,000 LN patients who received cyclophosphamide, mycophenolate mofetil or azathioprine.
We hypothesize that we will demonstrate significantly different infection rates by immunosuppressant medication. These findings from this large cohort of Medicaid enrollees with SLE and LN will help guide clinicians’ choice of medication for patients with moderate-to-severe disease.