Meet VF Young Investigator Audra Horomanski, MD
Early Inspiration and Commitment to Vasculitis Research
Dr. Horomanski’s journey into vasculitis research began during her residency and fellowship. “I took care of a number of patients with vasculitis during my residency and fellowship who were very ill and made incredible recoveries with our current therapies,” she recalled. This experience deeply impacted her, solidifying her commitment to the field. “Seeing the difference we can make as rheumatologists in the lives of these patients always stuck with me, we have the privilege of helping people get their lives back.”
Beyond the profound patient impact, Dr. Horomanski finds the intellectual challenge of vasculitis compelling, noting that, “Intellectually, vasculitides always keep me on my toes – they can affect every organ system, sometimes in unusual ways, so you really have to think about the whole person when considering their care.”
A Rising Leader in Vasculitis Care and Research
The Vasculitis Foundation’s (VF’s) 2025 Young Investigator Award has been granted to Dr. Horomanski, a dedicated rheumatologist whose passion for improving the lives of vasculitis patients shines through her work. As the Director of the Stanford Vasculitis Clinic and Program Director of the Rheumatology Fellowship in the Division of Immunology and Rheumatology at Stanford University, she is at the forefront of patient care, medical education, and groundbreaking research.
Advancing Family Planning Research for Vasculitis Patients
As a Young Investigator, Dr. Horomanski is honored to be supported by the VF, an organization that “does an incredible amount of advocacy for our patients and supports vasculitis research.” Her primary goal is to empower vasculitis patients in their family planning journeys. “My big goal is to better understand how the different types of vasculitis and the needed treatments affect pregnancy so that we can better guide our patients in their family planning journeys,” she stated. This critical area of research will provide much-needed guidance for patients and their healthcare providers.
Expert Support and Mentorship
“Research is growing around pregnancy outcomes and risks in people with vasculitis, which is really exciting and much needed,” said Dr. Horomanski’s mentor, Julia Fridman Simard, ScD. “As the Director of the Stanford Vasculitis Clinic, Dr. Horomanski is dedicated to providing optimal care for her patients, which has also motivated her commitment to research. Her work will be key to informing clinical care of patients with vasculitis during pregnancy and considers the complex interplay between pregnancy risks and medications to manage vasculitis.” Dr. Simard is an Associate Professor of Epidemiology & Population Health, and of Medicine in Immunology and Rheumatology and Obstetrics and, by courtesy, Gynecology in Maternal Fetal Medicine at Stanford University School of Medicine.
Investigating Azathioprine Use and Pregnancy Outcomes
Dr. Horomanski’s current research focuses on the use of azathioprine, a medication often prescribed to pregnant patients with autoimmune diseases. She explained that while azathioprine has been used successfully for decades, a recent Food and Drug Administration safety alert highlighted a potential link between thiopurines (the class of medication that includes azathioprine) and an increased risk of intrahepatic cholestasis of pregnancy (ICP) in patients with inflammatory bowel disease and lupus.
“We unfortunately have no data on the number of pregnant patients with vasculitis that experience ICP and any association with azathioprine,” Dr. Horomanski said. To address this gap, her team is utilizing a nationwide database spanning nearly two decades to investigate this potential connection. The long-term implications for patients are significant. “If we know how common ICP is in pregnant patients with vasculitis, we can counsel and monitor for it more effectively. If there is a signal for an increased risk with azathioprine, we can do things like monitor bile acid levels more frequently in patients who need this medication during pregnancy.”
Overcoming the Challenges of Rare-Disease Pregnancy Research
Researching rare diseases like vasculitis, especially in the context of pregnancy, presents unique challenges. “The hardest part of doing research on vasculitis and pregnancy is the rarity of these diseases,” Dr. Horomanski acknowledged. To overcome this, her team primarily uses large, nationwide samples. Working with extensive databases of claims and pharmacy data can have inherent challenges, such as ensuring accurate patient classification. “After working with this database in a number of prior studies, we have developed strategies for reducing the misclassification of patients, therapies, and outcomes,” she noted.
Expert Support and Mentorship
Dr. Horomanski envisions her study contributing to a broader understanding of pregnancy in vasculitis patients. “For a long time, patients with vasculitis were recommended to not pursue pregnancy due to the use of medications harmful to the fetus or disease manifestations that made pregnancy very high risk,” she said. However, “Improvements in therapy have really opened up the reproductive opportunities for our patients, but we are still lacking in knowledge on how to best counsel and monitor them during their pregnancy.”
Ultimately, Dr. Horomanski’s dedication to her work stems from a deep well of passion. “I really love what I do,” she shared. “Working to improve the lives of patients with vasculitis is easily one of the best parts of my job.”