Absence of varicella zoster virus reactivation after infliximab administration for plaque psoriasis

The risk of herpes zoster among patients with ankylosing spondylitis: A population-based cohort study in Taiwan

OBJECTIVES

The incident rate of herpes zoster (HZ) is higher in some autoimmune diseases; however the relationship of HZ and ankylosing spondylitis (AS) is still unclear. This research aims to determine the incidence of HZ in Taiwan AS patients.

METHODS

This study included 2819 AS patients and 11 276 non-AS controls between 2003 and 2013. All participants were selected from the Longitudinal Health Insurance Database 2000 Taiwan. The endpoint was diagnosis of HZ by International Classification of Diseases, Ninth Revision, Clinical Modification coding for at least 3 outpatient visits or one admission until the end of 2013. We used Chi-square test, Cox proportional hazard models and a Kaplan-Meier analysis to calculate the hazards ratio (HR), disease-free survival and incidental density of HZ. Subgroup analysis and sensitivity tests were also done.

RESULTS

Comorbidities such as chronic urticaria, inflammatory bowel disease, thyroid disorders, hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, cerebrovascular accident, were higher in patients with AS than that in controls. Patients age ≥60 or comorbid disease such as thyroid disorders or cancer had a higher HR of HZ; the adjusted HRs were 2.273 (95% CI 1.314-3.931), 1.577 (95% CI 1.008-2.466) and 1.855 (95% CI 1.248-2.758) respectively, on multivariable modeling. The crude HR for HZ among AS patient was 1.178 (95% CI 0.953-1.455, P > 0.05), and the adjust HZ was 1.070 (95% CI 0.835-1.371, P > 0.05), compared to non-AS controls.

CONCLUSIONS

There is no difference in incidence rate of HZ between Taiwan AS patients and non-AS controls. Among AS patients, age and cancer were major risk factors for incidental HZ.

Increased risk of herpes zoster in patients with psoriasis: A population-based retrospective cohort study

Objectives

The risk of herpes zoster (HZ) between patients with psoriasis receiving and not receiving systemic therapy has received increasing attention. This study investigated the association of psoriasis with the risk of HZ.

Methods

We conducted a population-based retrospective cohort study by using the Taiwan National Health Insurance Research Database. The psoriasis cohort consisted of 4077 patients with newly diagnosed psoriasis between 2000 and 2006. Each patient with psoriasis was frequency-matched with four people without psoriasis, by sex, age and index year. (nonpsoriasis cohort; 16308 subjects). Patients who received systemic therapy were classified as having severe psoriasis, whereas those who did not receive systemic therapy were classified as having mild psoriasis. The Cox proportional hazards regression analysis was conducted to estimate the association between psoriasis and HZ risk.

Results

The overall incidence density rate of HZ in the psoriasis cohort than in the nonpsoriasis cohort (4.50 vs. 3.44 per 1,000 person-years), with a multivariable Cox proportional hazards model measured adjusted HR of 1.29 [95% confidence interval (CI) = 1.07–1.56]. In additional, compared with the nonpsoriasis cohort, the risk of HZ was higher in the severe psoriasis cohort than in the nonpsoriasis cohort (adjusted hazard ratio [HR], 1.61; 95% confidence interval [CI], 1.15–2.27). The comparison between psoriasis and nonpsoriasis cohorts revealed a greatest magnitude risk of HZ in women (adjusted HR, 1.36; 95% CI, 1.04–1.79), study participants in the age group of 20–39 years (adjusted HR, 1.77; 95% CI, 1.17–2.66), and study participants without any comorbidities (adjusted HR, 1.37; 95% CI, 1.02–1.84).

Conclusions

Our results suggest that psoriasis is associated with an increased risk of HZ, which involves differences in sex and age. Although systemic therapy may have a major role in the risk of HZ, the intrinsic factors of psoriasis cannot be excluded.