University of Wisconsin Hospital and Clinics Madison, WI, United States
Freddy Caldera, DO, MS1, Siddharth Singh, MD2, Jonathan Inselman, MPH3, Kavya Swarna, MPH4, Andrew Keavney, MD5, Mary Hayney, PharmD1, Francis A. Farraye, MD, MSc5 1University of Wisconsin Hospital and Clinics, Madison, WI; 2UC San Diego Health, La Jolla, CA; 3Mayo Clinic, Rochester, MN; 4Mayo Clinic College of Medicine, Rochester, MN; 5Mayo Clinic, Jacksonville, FL
Introduction: Patients with inflammatory bowel disease (IBD) are at an increased risk for vaccine preventable infections such as herpes zoster (HZ). Immunosuppressed populations are at increased risk for complications from HZ such as post-herpetic neuralgia (PHN). The aim of this study was to determine if complications of HZ are more frequent in patients with IBD than in the general population.
Methods: This was a retrospective age matched cohort study using the Optum Research Database from 2007 through 2020 using pharmacy and administrative data. We identified patients with IBD who had > 2 medical claims for IBD and had 12 months baseline coverage and 3 months after index date which was defined as a diagnosis of HZ. We then identified complications of HZ (PHN, ophthalmic, neurologic, or disseminated) that occurred up to 90 days after the index date. We compared patients with IBD with HZ compared to patients without IBD or on a medication used to treat IBD with HZ, and evaluated 90-days risk of HZ complications. Cases were matched based on age, gender, and index year. We evaluated medication exposure within the past month for any oral medication and 3 months for any patients on a biologic. We also evaluated immunization with a HZ vaccine within the past year. Using a composite primary outcome of any HZ complication, we compared patients with IBD and age matched controls. Secondary outcomes evaluated individual HZ complications such as PHN.
Results: 16,969 patients with IBD met the inclusion criteria and were matched to controls. Patient with IBD had higher Charlson comorbidity scores compared to those without IBD (2.13 vs. 1.31 p value < 0.0001) (Table 1). Patients with IBD were more likely to have any HZ complications than matched controls [2811 (17.49%) vs 2220 (13.8%) p value < 0.0001]. They were also more likely to be hospitalized, have disseminated HZ, develop PHN, or neurologic complications compared to matched controls (Table 2). Those with higher comorbidity scores were more likely to have HZ complications (2.68 vs. 2.01 p value < 0.0001). In logistic regression analysis, Hispanic ethnicity, anti-TNF therapy, thiopurine use, prednisone and increased age were all associated with an increased risk for any HZ complication.
Discussion: Our study shows that patients with IBD are more likely to have complications of HZ compared to controls and these complications are common. Efforts are needed to increase HZ vaccine uptake among patients with IBD to potentially prevent HZ complications.
Siddharth Singh indicated no relevant financial relationships.
Jonathan Inselman indicated no relevant financial relationships.
Kavya Swarna indicated no relevant financial relationships.
Andrew Keavney indicated no relevant financial relationships.
Mary Hayney indicated no relevant financial relationships.
Francis Farraye: GSK – Consultant.
Freddy Caldera, DO, MS1, Siddharth Singh, MD2, Jonathan Inselman, MPH3, Kavya Swarna, MPH4, Andrew Keavney, MD5, Mary Hayney, PharmD1, Francis A. Farraye, MD, MSc5. P2620 - Patients With Inflammatory Bowel Disease Are at Increased Risk for Complications From Herpes Zoster, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.