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

Abstract

Aim To identify clinical risk factors associated with herpes zoster (HZ) infections in systemic lupus erythematosus (SLE). Methods A case‐control study of HZ infection was performed in SLE patients seen at the University of Santo Tomas Lupus Clinics from 2009‐2014. Cases were matched 1:2 to SLE controls without HZ infection for age, sex, and disease duration. Clinical characteristics, SLE disease activity, and immunosuppressive use were compared. Results Sixty‐five SLE patients (61, 93.8% female) who developed HZ were matched with 130 SLE patients without HZ. Mean age was 36.75 years (±1.35; P = 1.00) for the case group; mean SLE disease duration at first HZ infection was 6.1 years (±3.3; P = .919). Four patients had more than 1 episode of HZ. There was localized HZ in 63/65 (97%), and 2 (3%) disseminated HZ infections. The case group received higher doses of prednisone 64/65 (P = .012), mean prednisone dose 18.62 mg/d (±1.48, P < .001) and more were exposed to cyclophosphamide (Cyc) (19/65; P < .001) compared to the control group's mean prednisone dose of 11.73 mg/d (±1.16); there was Cyc use in 7/130 patients. Cyc in addition to mycophenolate mofetil (MMF) use among lupus nephritis patients conferred the highest risk for HZ infection occurrence. Hydroxychloroquine (HCQ) use reduced the risk for HZ by 87% (adjusted odds ratio 0.13, P = .003). Conclusion Immunosuppressives and corticosteroid use are risk factors associated with the development of HZ in SLE. The risk for HZ increases among patients given intravenous Cyc and MMF for lupus nephritis. SLE disease activity did not show a direct association with HZ occurrence. HCQ use appeared to have a protective role against HZ infection.

Rethinking the role of hydroxychloroquine in the treatment of COVID‐19

“…A third large cohort study of more than 24 000 patients with RA also found the risk of infection requiring hospitalization or outpatient parenteral antibiotics was less for those on HCQ compared with biologic disease‐modifying antirheumatic drugs 56 . Additionally, a small case‐control study of patients with SLE matched 65 patients that developed herpes zoster with 130 that did not and found a reduced the risk of Herpes zoster infection in those receiving HCQ 57 . Furthermore, there has been no signal of elevated infection risk or exacerbation of chronic infections for patients on HCQ and there is, therefore, no warning about infection risk on the FDA label on this drug.…”

Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents

“…43 , 44 Based on studies examining the risk of herpes zoster in patients being treated for various rheumatologic diseases, dosages of prednisone of over 7.5 mg per day were sufficient to increase the likelihood of developing herpes zoster. 45 - 47 Many of these children with chronic rheumatologic diseases were taking prednisone for long periods. However, some of the cases of herpes zoster occurred within weeks of starting prednisone therapy.…”

Hydroxychloroquine in systemic lupus erythematosus: overview of current knowledge

“…168 HCQ might inhibit the conversion of 25-(OH)vitamin D to 1,25-(OH)2-vitamin D. 200 However, data regarding the impact of HCQ on bone metabolism in SLE remain controversial. 86,162,163,201,202 Many data suggest that HCQ has a protective role against infections 92,116,[154][155][156][157][158][159][160] and severe events included 92,[154][155][156] in SLE.…”