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• W2886881295 abstract "To the Editor: With the advent of a highly effective recombinant subunit vaccine for herpes zoster (HZ),1Lal H. Cunningham A.L. Godeaux O. et al.Efficacy of an adjuvanted herpes zoster subunit vaccine in older adults.N Engl J Med. 2015; 372: 2087-2096Crossref PubMed Scopus (801) Google Scholar there is a need to identify which patients with inflammatory skin disease, some of whom may be candidates for immunomodulatory therapy, warrant vaccination for HZ. We performed a retrospective cohort analysis using the Explorys database to compare incidence of HZ among patients with and without hidradenitis suppurativa (HS). The Systematized Nomenclature of Medicine Clinical Terms hidradenitis and herpes zoster, which have one-to-one mapping with the International Classification of Diseases, Ninth Revision, codes for HS (705.83) and HZ (053), were used to identify the case cohort and those with the outcome of interest, respectively. This method of cohort identification has been validated for both conditions.2Garg A. Kirby J.S. Lavian J. Lin G. Strunk A. Prevalence estimates for hidradenitis suppurativa in the United States: a gender and age adjusted population analysis.JAMA Dermatol. 2017; 153: 760-764Crossref PubMed Scopus (199) Google Scholar, 3Klompas M. Kulldorff M. Vilk Y. Bialek S.R. Harpaz R. Herpes zoster and postherpetic neuralgia surveillance using structured electronic data.Mayo Clin Proc. 2011; 86: 1146-1153Abstract Full Text Full Text PDF PubMed Scopus (82) Google Scholar The study population included patients with active status in the database from 2012 to 2017. Patients with HIV infection, malignant neoplastic disease, and a history of receipt of a tissue or organ transplant were excluded. Immunosuppression (IS) was defined as having received a prescription for adalimumab, infliximab, methotrexate, cyclosporine, azathioprine, or a glucocorticoid. The incidence of HZ was compared between patients with HS and without HS, stratified by immunosuppressant use, on the basis of adjusted odds ratios from a logistic regression model that included terms for HS status, IS, sex, age, and the interaction between HS status and IS. We identified 30,355 patients with HS; their characteristics are described in Table I. Among those patients who did not receive IS, the crude incidences of HZ were 0.42% (85 of 20,105) and 0.38% (81,500 of 21,542,350) among patients with HS and without HS, respectively (P < .0020). In this group, patients with HS had increased odds of developing HZ compared with patients without HS in unadjusted (odds ratio [OR], 1.12; 95% confidence interval [CI], 0.90-1.38) and adjusted (OR, 1.40; 95% CI, 1.13-1.73) analyses.Table ICharacteristics of patients with HS and controlsCharacteristicPatients with HS, n (%)(n = 30,355)Patients without HS, n (%)(n = 25,318,800)Sex Female22,560 (74.3%)14,317,480 (56.5%) Male7,795 (25.7%)11,001,320 (43.5%)Age, y 18-4420,295 (66.9%)11,301,670 (44.6%) 45-648,395 (27.7%)8,293,940 (32.8%) ≥651,665 (5.5%)5,723,190 (22.6%)IS prescription Yes10,250 (33.8%)3,776,450 (14.9%)HZ infection Yes215 (0.7%)120,370 (0.5%)HS, Hidradenitis suppurativa; HZ, herpes zoster; IS, immunosuppression. Open table in a new tab HS, Hidradenitis suppurativa; HZ, herpes zoster; IS, immunosuppression. A prescription for IS was given to 33.8% of patients with HS (10,250 of 30,355) and 14.9% of patients without HS (3,776,450 of 25,318,800). Among the patients receiving IS, the crude incidences of HZ were 1.27% (130 of 10,250) and 1.03% (38,870 of 3,776,450) among patients with HS and without HS, respectively (P < .0001). Compared to patients without HS, patients with HS who were receiving IS had an increased risk of developing HZ in unadjusted (OR, 1.24; 95%, CI 1.04-1.47) and adjusted (OR, 1.49; 95% CI, 1.25-1.77) analyses (Table II).Table IIIncidence of herpes zoster among patient subgroups (April 2012-April 2017)Medication groupIncidence of herpes zoster (No. of new cases/total no. of patients)Unadjusted odds ratio (95% CI)Adjusted odds ratio (95% CI)∗Odds ratio derived from a logistic regression model including an interaction term for HS*immunosuppressant use in addition to main effect terms for HS, immunosuppressant use, sex, and age. The interaction between HS and immunosuppressant use was not significant (P = .67).P value†Corresponds to the adjusted odds ratio.Patients with HS (n = 30,355)Patients without HS (n = 25,318,800)Immunosuppression130/10,250 (1.27%)38,870/3,776,450 (1.03%)1.24 (1.04-1.47)1.49 (1.25-1.77)<.0001No immunosuppression85/20,105 (0.42%)81,500/21,542,350 (0.38%)1.12 (0.90-1.38)1.40 (1.13-1.73)<.0020CI, Confidence interval; HS, hidradenitis suppurativa.∗ Odds ratio derived from a logistic regression model including an interaction term for HS*immunosuppressant use in addition to main effect terms for HS, immunosuppressant use, sex, and age. The interaction between HS and immunosuppressant use was not significant (P = .67).† Corresponds to the adjusted odds ratio. Open table in a new tab CI, Confidence interval; HS, hidradenitis suppurativa. Patients with HS who were not receiving IS had a very low incidence of HZ. Exposure to IS was associated with a tripling of the crude incidence of HZ, although the incidence was still less than 2%. The likelihood of development of HZ among patients with HS, compared to patients without HS, was similar regardless of exposure to IS, suggesting that IS use does not modify the relationship between HS and HZ. The incidence of HZ among patients with HS appears to approximate the rates observed in the general US population. In a claims-based analysis, the overall incidence rate of HZ among adults was observed to be 4.47 per 1000 person-years.4Johnson B.H. Palmer L. Gatwood J. Lenhart G. Kawai K. Acosta C.J. Annual incidence rates of herpes zoster among an immunocompetent population in the United States.BMC Infect Dis. 2015; 15: 502-506Crossref PubMed Scopus (83) Google Scholar We could not account for HZ vaccination in this analysis. Because of the low number of events in each group, we could not stratify risk of HZ by type of IS. We conclude that risk of development of HZ infection among patients with HS is only slightly higher than among patients without HS. The risk however is still low, even with exposure to IS. Although the need for vaccination should be assessed for patients individually, those with HS generally may not require HZ vaccination, even with immunomodulation, before the age of 50 years." @default.
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• W2886881295 date "2018-12-01" @default.
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• W2886881295 title "Incidence of herpes zoster among patients with hidradenitis suppurativa: A retrospective population-based cohort analysis" @default.
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