Clinical Edge

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Risk of Herpes Zoster With Pharmacotherapy for IBD

Clin Gastroenterol Hepatol; 2018 Dec; Khan, et al

In a nationwide cohort study of veteran populations, inflammatory bowel disease (IBD) and treatment with thiopurines, alone or in combination with tumor necrosis factor (TNF) antagonists, was associated with increased risk of herpes zoster (HZ). Researchers conducted 2 retrospective studies of populations of veterans, from January 2000 through June 2016. Study 1 compared the incidence of HZ among patients with IBD receiving 5-ASA alone vs match patients without IBD. Study 2 compared the incidence of HZ among patients with IBD treated with only 5-ASA, with thiopurines, with antagonists of TNF, with a combination of thiopurines and TNF antagonists, and with vedolizumab. They found:

  • Compared to no IBD, ulcerative colitis (UC) and Crohn’s disease (CD) were each associated with significantly increased risk of HZ infection.
  • UC, CD, or IBD treated with 5-ASA treatment alone was associated with significantly increased risk of HZ.
  • Compared to exposure to 5-ASA alone, exposure to thiopurines or a combination of thiopurines and TNF antagonists was associated with increased risk of HZ.
  • However, exposure to TNF antagonists alone was not associated with increased risk of HZ.

Citation:

Khan N, Patel D, Trivedi C, et al. Overall and comparative risk of herpes zoster with pharmacotherapy for inflammatory bowel disease: A nationwide cohort study. Clin Gastroenterol Hepatol. 2018;16(12):1919-1927. doi:10.1016/j.cgh.2017.12.052.