Journal Article

POS1161 RETROSPECTIVE ANALYSIS OF HERPES ZOSTER INFECTION IN A LARGE COHORT OF SLE PATIENTS: RISK AND PROTECTIVE FACTORS

Arru, F., Rahme, Z., Hulej, G., Zen, M., Vesentini, F., Gennaio, I., Cruciani, C., Doria, A.

2024

Overview

Background:SLE is burdened by an increased incidence and prevalence of Herpes Zoster (HZ) infection compared to the general population. Some patient features are known to be risk factors for HZ occurrence, including disease-related and treatment-related factors.Objectives:to analyse HZ infection incidence, episode characteristics, and risk factors in a large SLE cohort in the pre-non-live recombinant vaccine era.Methods:retrospective analysis based on clinical records collected at our SLE clinic from 2008. We considered only HZ episodes occurring after SLE diagnosis. We collected information regarding characteristics of HZ episodes, demographics, disease assessments prior to and after HZ episodes, including treatments administered up to a year before the episode. We also considered the presence of other immune deficits not captured by standard routine blood tests, including hypogammaglobulinemia and lymphocyte subpopulations cytopenias. By means of univariate analyses, data from patients with HZ infection were compared with those from other patients of our SLE cohort.Results:Among our 586 SLE patients, we found 112 episodes of HZ occurring among 109 SLE patients, with a prevalence rate of 19% and an incidence rate of 0.84 per 100 patients/year.HZ event features and characteristics of patients at HZ event are summarized in Tab1. No patient had ever received a HZ-vaccine before the HZ episode.Compared to the rest of our SLE cohort, HZ patients did not differ regarding demographics, including age and disease duration.HZ patients displayed higher exposure (ever) to immunosuppressants (IS) (.033), especially MMF/MFA (.004), a less frequent discontinuation of IS (.021), and a significantly lower frequency of prolonged remission (.046). In addition, leucopenia was more frequent (.045).Notably, SDI (SLICC Damage Index) (.68), aPL positivity ever, renal (and CKD), neurological or vascular involvement, HCQ exposure ever did not differ between HZ patients and controls. Of note, exposure to belimumab or rituximab (in the previous 12 months) was not associated with an increased risk of HZ.Among patients with HZ higher cSLEDAI (.027) and higher GCs cumulative dose (<.001), but not the type of IS used, were associated with post-herpetic neuralgia. Lymphopenia use was associated with HZ multi-site involvement.Conclusion:This work analyses HZ incidence, characteristics and risk factors in a large SLE cohort. In contrast with previous studies1,2, no impact of disease duration or age was seen. Disease severity did not influence HZ risk. Furthermore, despite IS therapies being generally associated with an increased HZ risk, some of them, including Belimumab and rituximab, seem not to share the same burden.REFERENCES:[1] Ryu et al., «Risk factors for herpes zoster in patients with rheumatic diseases».[2] Kwan et al., «Herpes Zoster in SLE».Acknowledgements:NIL.Disclosure of Interests:None declared.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Comorbidities / Demography / Disease / Disease-modifying Drugs (DMARDs) / Epidemiology / Glucocorticoids / Herpes viruses / Herpes zoster / Hypogammaglobulinemia / Immunosuppressive agents / Immunotherapy / Infections / Leukopenia / Lymphocytes / Lymphopenia / Monoclonal antibodies / Neuralgia / Patients / Prognostic factors / Remission / Risk factors / Rituximab / Scientific Abstracts / Systemic lupus erythematosus / Vaccines