Chloroquine diphosphate: a risk factor for herpes zoster in patients with dermatomyositis/polymyositis

Abstract

OBJECTIVES:Herpes zoster has been widely described in the context of different systemic autoimmune diseases but not dermatomyositis/polymyositis. Therefore, we analyzed the prevalence, risk factors and herpes zoster outcomes in this population.METHOD:A retrospective cohort study of herpes zoster infections in dermatomyositis/polymyositis patients was performed. The patients were followed at a tertiary center from 1991 to 2012. For the control group, each patient with herpes zoster was paired with two patients without herpes zoster. Patients were matched by gender and the type of myositis, age at myositis onset and disease duration.RESULTS:Of 230 patients, 24 (10.4%) had a histories of herpes zoster (19 with dermatomyositis and five with polymyositis, two-thirds female). The mean age of the patients with herpes zoster was 44.6±16.8 years. No difference between the groups was found regarding cumulative clinical manifestations. Disease activity, autoantibody, muscle and leukogram parameters were also comparable between the groups. No differences in immunosuppressive (alone or in association with other immunosuppressive therapies) or glucocorticoid (current use, medium dose and cumulative dose in the last two months) therapies were found between patients with and without herpes zoster. However, a higher proportion of patients in the herpes zoster group received chloroquine diphosphate compared to the control group. All of the patients received acyclovir; 58.3% of patients had postherpetic neuralgia and no cases of recurrence were reported. Furthermore, individuals who were taking high prednisone doses at the time of the herpes zoster diagnosis had reduced levels of postherpetic neuralgia.CONCLUSIONS:These data suggest that chloroquine diphosphate could predispose patients with dermatomyositis/polymyositis to developing herpes zoster, particularly women and dermatomyositis patients.

Risk factors for herpes zoster infection among Filipinos with systemic lupus erythematosus

“…Cunha et al reported chloroquine diphosphate could predispose patients with dermatomyositis/polymyositis to develop HZ . However, in this study the aOR for hydroxychloroquine was 0.13 (95% CI 0.03‐0.49; P = .003) and more patients were on hydroxychloroquine in the control group (non‐HZ group), moreover the dose of hydroxychloroquine was higher in the non‐HZ group with a mean daily dose of 193.08 mg (±7.42) compared to the HZ group's mean daily dose of 156.92 mg (±15.5), P = .018; which demonstrates that higher doses of hydroxychloroquine may have an intriguing possible protective effect in preventing HZ infection through an unknown mechanism.…”

“…Cunha et al reported chloroquine diphosphate could predispose patients with dermatomyositis/polymyositis to develop HZ. 19 However, In conclusion, the study demonstrated that exposure to immunosuppressive agents and corticosteroids increased the risk for HZ infection. Hydroxychloroquine, on the other hand, may have a pleiotropic protective action against the development of HZ infection.…”

The incidence of herpes zoster in cutaneous lupus erythematosus (CLE), dermatomyositis (DM), pemphigus vulgaris (PV), and bullous pemphigoid (BP)

“…Prior studies found that patients with DM on chloroquine had a 6-fold increased risk of zoster compared with those not on chloroquine, 19 and that the use of hydroxychloroquine in rheumatoid arthritis was associated with a statistically significant increased risk of zoster. 20 Antimalarials may decrease interferon production from peripheral blood mononuclear cells via Toll-like receptors 7 and 9 and consequently depress the immune response to viral infections.…”

Mycophenolate mofetil in patients with refractory systemic autoimmune myopathies: case series

“…MMF has been used in several systemic autoimmune diseases, such as systemic sclerosis, rheumatoid arthritis, Sjögre's syndrome, systemic lupus erythematosus [16,[27][28][29]. However, there are few studies in the literature investigating the use of MMF in adult patients with SAM [10][11][12][13][14][15][16][17][18][19][20].…”