Herpes zoster infection in patients who are on biologic immunosuppressant for autoimmune rheumatic disorder.

Lih En Hong, Mihir D Wechalekar, Liz Briggs, Fiona Goldblatt, Eliza Pontifex, Fin Cai, Michael Shanahan, Jenny Walker

Research output: Contribution to journalMeeting Abstractpeer-review

Abstract

Introduction: Patients with autoimmune rheumatic disorders who are on conventional synthetic disease modifying antirheumatic drugs (csDMARDs), biologic disease modifying antirheumatic drug (bDMARD) and corticosteroid are at higher risk of herpes zoster infection. This study describes the experience of a cohort of patients with rheumatic diseases on biologic treatments with respect to herpes zoster infection.

Method: Patients on a bDMARD within the Southern Adelaide Local Health Network, (n = 274) in 2018 were invited to complete a questionnaire based survey.

Result: 45% (n = 123) responded to the questionnaire survey. 15% (n = 19) had herpes zoster infection following commencement of a bDMARD. The mean age of occurrence of shingles was 64.42 years; rheumatoid arthritis was the most common rheumatological diagnosis in 42.1% (n = 8), followed by psoriatic arthritis 36.8% (n = 7), and ankylosing spondylitis 21.1% (n = 4). The majority of those developing infections were receiving tumour necrosis factor inhibitor (TNF-i) (89.5%; n = 17). 21% (n = 4) of those who had experienced a prior episode of herpes zoster infection, developed another episode of herpes zoster infection after initiation of bDMARD. Herpes zoster vaccination rate among responders was low. Only 26.3% (n = 5) had herpes zoster vaccination prior to commencement of bDMARD. The most common site of herpes zoster infection involved the thoracolumbar dermatomes 57.9% (n = 11). 95% (n = 18) received therapy for herpes zoster infection.

Conclusion: Patients with autoimmune rheumatic disorders who are on biologic therapy are at increased risk of herpes zoster infection. While the current recommendation is for patients above 60 years old to receive herpes zoster vaccination, younger patients with autoimmune rheumatic disorders may benefit from herpes zoster vaccination prior to commencement of biologic therapy.
Original languageEnglish
Pages (from-to)38
Number of pages1
JournalInternal Medicine Journal
Volume50
Issue numberSupplement 2
DOIs
Publication statusPublished - Jul 2020
EventAustralian Rheumatology Association 60th Annual Scientific Meeting -
Duration: 16 May 202019 May 2020

Keywords

  • csDMARDs
  • bDMARD
  • corticosteroid
  • herpes zoster
  • autoimmune rheumatic diseases

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