Increased risk of herpes zoster in patients with psoriasis: A population-based retrospective cohort study

Abstract

ObjectivesThe risk of herpes zoster (HZ) between patients with psoriasis receiving and not receiving systemic therapy has received increasing attention. This study investigated the association of psoriasis with the risk of HZ.MethodsWe conducted a population-based retrospective cohort study by using the Taiwan National Health Insurance Research Database. The psoriasis cohort consisted of 4077 patients with newly diagnosed psoriasis between 2000 and 2006. Each patient with psoriasis was frequency-matched with four people without psoriasis, by sex, age and index year. (nonpsoriasis cohort; 16308 subjects). Patients who received systemic therapy were classified as having severe psoriasis, whereas those who did not receive systemic therapy were classified as having mild psoriasis. The Cox proportional hazards regression analysis was conducted to estimate the association between psoriasis and HZ risk.ResultsThe overall incidence density rate of HZ in the psoriasis cohort than in the nonpsoriasis cohort (4.50 vs. 3.44 per 1,000 person-years), with a multivariable Cox proportional hazards model measured adjusted HR of 1.29 [95% confidence interval (CI) = 1.07–1.56]. In additional, compared with the nonpsoriasis cohort, the risk of HZ was higher in the severe psoriasis cohort than in the nonpsoriasis cohort (adjusted hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.15–2.27). The comparison between psoriasis and nonpsoriasis cohorts revealed a greatest magnitude risk of HZ in women (adjusted HR, 1.36; 95% CI, 1.04–1.79), study participants in the age group of 20–39 years (adjusted HR, 1.77; 95% CI, 1.17–2.66), and study participants without any comorbidities (adjusted HR, 1.37; 95% CI, 1.02–1.84).ConclusionsOur results suggest that psoriasis is associated with an increased risk of HZ, which involves differences in sex and age. Although systemic therapy may have a major role in the risk of HZ, the intrinsic factors of psoriasis cannot be excluded.

Increased Risk of Herpes Zoster in Young and Metabolically Healthy Patients with Inflammatory Bowel Disease: A Nationwide Population-Based Study

“…A single-center retrospective study also showed that the risk of HZ was higher in younger patients who received liver transplantations, and this supports the need for vaccination among younger patients 23. A retrospective population-based study performed in Taiwan reported a high risk of HZ in patients with psoriasis who were aged between 20 and 39 years old 24. Taken together, these data indicate that younger patients with chronic inflammatory disorders that require systemic immunosuppressive therapy have a relatively higher risk than the general population of developing HZ.…”

Increased risk of chronic fatigue syndrome following psoriasis: a nationwide population-based cohort study

“…Severe psoriasis was defined as patients receiving phototherapy (e.g., ultraviolet B (psoralen) and ultraviolet A) and/or immunomodulatory drugs (e.g., methotrexate, azathioprine, ciclosporin, oral retinoids, hydroxyurea, mycophenolate mofetil, tacrolimus, etanercept, adalimumab, and ustekinumab). Patients not receiving phototherapy and/or immunomodulatory drugs for psoriasis were classified as having mild psoriasis [12].…”

A systematic literature review to assess the burden of herpes zoster disease in China

“…Differences in study setting and design will also impact estimates of other complications, as well as the costs associated with HZ. Some findings were unexpected, such as the observation in one study that the use of systemic steroids was strongly associated with a reduced risk of developing HZ [30]. This finding is difficult to interpret given that patients with psoriasis were likely to be receiving other immune-modulating drugs that may have influenced the risk of developing HZ.…”

“…The potential association was weaker in persons with depression, psychiatric disease, hyperlipidemia, hypertension, as well as those post-general anesthesia (range of HRs: 1.11-1.29) [20,25,26,28,29]. Conversely, systemic steroid use in patients with psoriasis was associated with a significantly reduced risk of HZ (HR: 0.6, 95% CI: 0.44-0.81) [30], as was radical prostatectomy and hormone therapy in patients with prostate cancer (HR: 0.60, 95% CI: 0.44-0.81) [31].…”