Immunosuppressive, corticosteroid use ups herpes zoster risk in Filipinos with SLE

Among Filipino patients with systemic lupus erythematosus (SLE), the use of immunosuppressive and corticosteroid contributes to an increased risk of developing herpes zoster (HZ) infection, a study has found. The risk is even higher in lupus nephritis patients exposed to intravenous cyclophosphamide and mycophenolate mofetil (MMF).

The study included 65 adult SLE patients (mean age, 36.75 years; 93.8 percent female) who developed HZ and 130 matched SLE controls without HZ seen at the University of Santo Tomas Lupus Clinics. Researchers evaluated clinical characteristics, SLE disease activity and immunosuppressive in relation to the risk of HZ.

Mean SLE disease duration at first HZ infection was 6.1 years, and four patients had more than one episode of HZ. The infection was localized in most patients (n=63; 97 percent), and two patients (3 percent) disseminated HZ infections.

Compared with those in the non-HZ group, patients in HZ group were exposed to higher doses of prednisone (mean, 18.62 vs 11.73 mg/d; p<0.001) and more frequently used cyclophosphamide (19/65 vs 7/130 patients; p<0.001). Exposure to the combination of cyclophosphamide plus MMF among lupus nephritis patients was associated with the highest risk of HZ infection.

On the other hand, hydroxychloroquine use reduced the risk of HZ by 87 percent (adjusted odds ratio, 0.13; p=0.003). SLE disease activity showed no direct association with the risk.