Incidence & Risk Factors for Herpes Zoster/IBD

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Gauree Gupta, Ebbing Lautenbach and D.

¢øCenters for Education and Research on

Therapeutics, University of Pennsylvania

School of Medicine,

Philadelphia, Pennsylvania

Background & Aims:

An increased risk of herpes zoster in patients with inflammatory bowel disease

(IBD) is hypothesized based on altered immune function, especially among

patients receiving immunosuppressive medications. Methods: We performed a retrospective

cohort study and a retrospective nested case-control study using

1988–1997 data from the General Practice Research Database. In the cohort study, 7823 Crohn¡Çs disease (CD) and

11,930 ulcerative colitis (UC) patients were matched on age, sex, and primary

care practice to 79,563 randomly selected controls without CD or UC. In the nested case-control study, 185 CD patients with

zoster and 266 UC patients with zoster were matched on sex and year of birth to

1787 IBD patients without zoster. Results: In the cohort study, the

incidence of zoster was higher in patients with CD and UC compared with their

matched controls (UC incidence rate ratio, 1.21; 95% confidence interval [CI],

1.05–1.40; CD incidence rate ratio, 1.61; 95% CI, 1.35–1.92). In the nested case-control study, receipt of a

prescription for corticosteroids (adjusted odds ratio, 1.5; 95% CI,

1.1–2.2) or azathioprine/6-mercaptopurine (adjusted odds ratio, 3.1; 95%

CI, 1.7–5.6) were both associated with zoster. Conclusions: Patients with IBD, especially those on immunosuppressive

medications, are at higher risk for herpes zoster compared with the general

population. Future studies should clarify the relative

risk associated with anti–tumor necrosis factor ¦Á therapies and

determine the use of the new zoster vaccine for patients with IBD.