Colon to Rectum
Inflamm Bowel Dis. 2022;28(2):176–82
Anti-TNF therapy and the risk of herpes zoster among patients with inflammatory bowel disease
Background: The specific contribution of anti-tumor necrosis factor (TNF) therapy to the onset of herpes zoster (HZ) in patients with inflammatory bowel disease (IBD) remains uncertain. Thus, the purpose of this nested case-control study was to explore whether the use of anti-TNF therapy is associated with an increased risk of HZ.
Methods: Using the Regie de l’Assurance Maladie du Québec, the authors identified incident cases of IBD between 1998 and 2015. They matched IBD cases of HZ with up to 10 IBD HZ-free controls on year of cohort entry and follow-up. Current use was defined as a prescription for anti-TNF therapy 60 days before the index date, with non-use as the comparator. Conditional logistic regression was conducted to estimate odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for potential confounders.
Results: The cohort consisted of 15,454 incident IBD patients. Over an average follow-up of 5.0 years, 824 patients were diagnosed with HZ (incidence of 9.3/1000 person-years). Relative to non-use, current use of anti-TNF therapy was associated with an overall increased risk of HZ (OR = 1.5; 95% CI: 1.1–2.1). The risk was increased among those older than 50 years (OR = 2.1; 95% CI: 1.2–3.6) and those additionally using steroids and immunosuppressants (OR = 4.1; 95% CI: 2.3–7.2).
Conclusions: Use of anti-tumor necrosis factor therapy was associated with an increased risk of herpes zoster (HZ) among patients with inflammatory bowel disease (IBD), particularly among those older than 50 years and those on combination therapy. Prevention strategies for HZ ought to be considered for younger IBD patients commencing treatment.