Abstract
Background
Patients with inflammatory bowel disease (IBD) on certain immunosuppressants have increased herpes zoster (HZ) risk.
Aim
To determine the risk of HZ in IBD and how anti-tumor necrosis factor-alpha (anti-TNF)agents affect this risk.
Methods
We performed a retrospective cohort and nested case-control study using administrative data from IMS LifeLink® Information Assets-Health Plan Claims Database. In the cohort, we identified IBD patients < age 64 by diagnosis codes; matched to 4 individuals without IBD. HZ risk was evaluated by incidence rate ratio (IRR) and adjusted Cox proportional hazards models (HR). In the nested case-control analysis, 2,659 IBD patients with HZ were each matched to 4 IBD patients without HZ. We determined associations between medications and HZ using conditional logistic regression.
Results
The cohort included 50,932 patients with Crohn’s disease (CD), 56,403 patients with ulcerative colitis (UC), and 1,269 with unspecified IBD, matched to 434,416 individuals without IBD. The IBD cohort had increased HZ risk compared to non-IBD (IRR 1.68, 95% CI 1.60-1.76). After adjustment, IBD patients had a higher risk of HZ than non-IBD (HR 1.49, 95% CI 1.42-1.57). In the nested case-control multivariate adjusted analyses, anti-TNF medications (OR 1.81, 95% CI 1.48-2.21), corticosteroids (OR 1.73, 95% CI 1.51-1.99) and thiopurines (OR 1.85, 95% CI 1.61-2.13) were independently associated with HZ. Risk of HZ was highest with combination anti-TNF and thiopurine therapy (OR 3.29, 95% CI 2.33-4.65).
Conclusions
Patients with IBD are at increased risk for HZ. Use of thiopurines, anti-TNF agents, combination therapy, and corticosteroids increases HZ risk.
