Tanja Tran

Tell us a bit about your background and how you ended up studying in this field.

I grew up in Germany and I have a Bachelor’s degree in Pharmaceutical Sciences and a Master’s degree in Epidemiology from the University of Munich. I didn’t know about McGill University until I was doing my master’s and had professors who spoke highly of their experience at McGill. When I started my master’s program, I was already interested in pharmacoepidemiology and decided to do an internship with Dr. Yola Moride at the University of Montreal in 2013.  I had not had much exposure to pharmacoepidemiology in Germany. During my internship in Montreal, Dr. Moride gave me the opportunity to learn more about pharmacoepidemiology, and one of the first things I did was attend the International Conference on Pharmacoepidemiology & Therapeutic Risk Management (ICPE). The internship and attending ICPE showed me the great variety of research that is done in this field. And it became clear to me that this would be the field of my future research. From then on, it took less than a year to start my PhD in epidemiology under the supervision of Dr. Suissa at McGill University. Once at McGill, I participated in workshops, meetings, and lectures organized by CNODES.  These were a great way to learn about new developments and methods in pharmacoepidemiology and to meet new contacts.

Please give us a summary of your research and why it is important.

Idiopathic pulmonary fibrosis (IPF) is a rare interstitial lung disease of unknown cause and poor prognosis. There are two anti-fibrotic drug treatments—pirfenidone and nintedanib—which were approved for treatment of IPF in recent years. However, these drug treatments are expensive and only slow disease progression. The search for other effective treatments of IPF continues.

As gastroesophageal reflux is common and may contribute to the disease progression in patients with IPF, anti-acid treatments have been conditionally recommended in international IPF treatment guidelines based on sparse and low-quality evidence. Additionally, concerns regarding the overutilization of those treatments, particularly proton pump inhibitors (PPIs) and adverse effects related to use of PPIs, highlight the need to investigate PPIs as a treatment option for IPF in a real-world setting.

As part of my research, Dr. Suissa and I conducted a methodological review. We found that the reported beneficial effects of anti-acid treatment in IPF were a result of immortal time bias which underlines the need for well-designed observational studies. The review represents the Introduction to my PhD research, and explains why there is the need for well-designed studies in this field. Currently, I am working on a cohort study to explore the effect of PPIs on this disease. I don’t have results yet, but because IPF is a rare disease, having a large population-based database increases the sample size and generalizability compared to studies that have already been done.

What excites you the most about the research you are doing or hope to do in the future?

I think that the majority of graduate students in epidemiology want to do research that is clinically relevant. I’m excited to have that opportunity by using real-world data and applying the appropriate methods to answer questions regarding drug effectiveness and safety. Particularly, for my research in IPF, where the average prognosis is poor and treatment options are limited, adding to the evidence will hopefully benefit patients with IPF and raise awareness for this disease.

What would you say you are most proud of?

I’m proud of having the methodological review with Dr. Suissa published. It’s always difficult to criticize other researchers’ papers and to have the audience acknowledge that there may have been biases in their studies. But I’m hoping that the review will have an impact by helping to avoid immortal time bias in the future, and to point out that well-designed studies are needed in the field of IPF.

Are there aspects of your work that you find particularly challenging or that you dislike?

Data management for my analyses was definitely challenging at the beginning, but the analysts at the Centre for Clinical Epidemiology at Lady Davis Institute are very helpful and I have definitely improved my skills a lot since starting the PhD program. For example, I work with the CPRD for my study and decisions about how to define potential confounders at cohort entry can be challenging because there may be multiple files from which we need to extract the relevant information. Fortunately, we students have really great support with all the analysts at the Centre, who are always willing to help. We analyze data on our own but discuss challenges in groups to find solutions.

Do you have specific career goals for the coming years that you would like to share?

I’m hoping to work as a pharmacoepidemiologist—if possible in Germany. I’m open to different possibilities. Germany has government-associated research institutes. Academia is an option or research with industry. And because training in pharmacoepidemiology is not as advanced in Germany, it would be a great opportunity to bring my knowledge back to Germany and to train others.

How has CNODES impacted your studies or career trajectory?

When I started my PhD at McGill, I first met other CNODES investigators and learned about the work of CNODES. Being in an environment with CNODES investigators, analysts, and assistants has definitely benefitted my research. Their expertise and the different training opportunities allow me to discover and learn about a variety of topics and methods in pharmacoepidemiology. CNODES is a great example of a research network where collaboration plays an important role—everyone contributes with their knowledge.

Are there specific CNODES lectures or workshops that you found particularly interesting/informative for your work?

One that stands out is from the last CNODES semi-annual meeting, where Dr. Sebastian Schneeweiss and Dr. Jeremy Rassen introduced their “rapid cycle” analytic platform Aetion. It’s fascinating to me how fast the field of pharmacoepidemiology develops and how quickly methods can be implemented and then used for practical applications as well.

[Note: The recording of Dr. Schneeweiss’ presentation will soon be available here.]

Outside of work and studies, what are you passionate about?

I have quite a few interests outside of work. I run and play badminton, I sing in a choir, and I enjoy cooking and baking a lot. In fact, I find that making bread, especially sourdough, is a great way to relax.

References

Methodological review

Tran T, Suissa S. The effect of anti-acid therapy on survival in idiopathic pulmonary fibrosis: a methodological review of observational studies. Eur Respir J. 2018 Jun 21;51(6). doi: 10.1183/13993003.00376-2018.

https://www.ncbi.nlm.nih.gov/pubmed/29724921

Related editorial

Kreuter M, Raghu G. Gastro-oesophageal reflux and idiopathic pulmonary fibrosis: the heart burn in patients with IPF can no longer be silent. Eur Respir J.  Jun 2018, 51 (6) 1800921.

https://erj.ersjournals.com/content/51/6/1800921