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Shingles hospitalization occurs more often among IBD patients



Hospitalizations for shingles is twice as common among patients with inflammatory bowel disease than in the general U.S. population, based on analysis of data from the National Inpatient Sample.

Dr. Daniela G. Vinsard, UCONN Health, Farmington, Conn. Mitchel L. Zoler/MDedge News

Dr. Daniela G. Vinsard

This elevated risk for patients with inflammatory bowel disease (IBD) to develop a herpes zoster virus (HZV) reactivation severe enough to put them in the hospital makes it especially important for IBD patients to receive immunization against shingles, especially now that a more effective vaccine is available, Daniela G. Vinsard, MD, said at the annual Digestive Disease Week®. Ideally, IBD patients should receive the full course of the adjuvanted, recombinant zoster vaccine Shingrix before starting an immunosuppressive regimen, said Dr. Vinsard, a physician at the University of Connecticut, Farmington.

This finding, which underscored the susceptibility of IBD patients to shingles because of their immunosuppressive treatments and the importance of vaccination, recently became even more relevant when the Food and Drug Administration approved tofacitinib (Xeljanz) to treat ulcerative colitis in late May, commented Gil Y. Melmed, MD, director of clinical inflammatory bowel disease at Cedars-Sinai Medical Center, Los Angeles. Tofacitinib, which may be an attractive option to some patients as an oral immunomodulator, carries a black box warning about the added risk for certain serious infections while taking the drug, including HZV. Recent recommendations from the American College of Gastroenterology said that IBD patients aged 51 years or older should “strongly consider” HZV vaccination, including immunosuppressed patients (Am J Gastroenterol. 2017 Feb; 112[2]:241-58). The introduction of a potentially popular drug for ulcerative colitis that’s known to pose a risk for shingles might lead to a stronger recommendation for vaccination in the near future, Dr. Melmed said in an interview.

The study Dr. Vinsard reported used data collected by the National Inpatient Sample from 2012 to September 2015, which represented, with weighting, more than 142 million hospitalized American patients. From this data set she and her associates identified 7,180 IBD patients hospitalized with a primary diagnosis of a vaccine-preventable disease, and about 589,000 weighted patients hospitalized for a vaccine-preventable disease but without IBD. The selection also focused on patients aged 18-65 years. Dr. Vinsard said that she excluded older patients to eliminate advanced age as a cause of immunosuppression.

Dr. Gil Y. Melmed, director of Clinical Inflammatory Bowel Disease at Cedars-Sinai Medical Center in Los Angeles.

Dr. Gil Y. Melmed

Among the IBD patients, HZV was the most frequent primary diagnosis, causing 35% of these hospitalizations. Other common infectious causes of hospitalization in this group were hepatitis B virus in 31% of cases, influenza in 22%, pneumonia in 9%, and other types of infections in the remaining 3%. In contrast, hepatitis B caused 35% of hospitalizations in patients without IBD, influenza caused 29%, pneumonia caused 14%, HZV caused 19%, and other infections accounted for 3% of admissions.

In a multivariate analysis that controlled for diabetes, HIV infection, cancer, and transplantation, the IBD patients had more than twice the rate of hospitalization for shingles, compared with the patients without IBD, Dr. Vinsard said. When broken down by specific disease type, the rate of HZV infection was 110% higher among ulcerative colitis patients, compared with the general population, and was 140% higher in Crohn’s disease patients, both statistically significant differences.

An additional finding from the analysis was that during the 4 years of study, the rate of hospitalizations of IBD patients for influenza steadily rose, from about 10% in 2012 to nearly 30% in 2015.

Dr. Vinsard reported no disclosures. Dr. Melmed reported consulting with Pfizer, the company that markets tofacitinib, and with several other companies that market biological agents.

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