Santella Christina, Bitton Alain, Filliter Christopher, Bessissow Talat, Vutcovici Maria, Lakatos Peter L, Brassard Paul
Center for Clinical Epidemiology, Lady Davis Research Institute, Jewish General Hospital, Montreal, Quebec, Canada.
Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal General Hospital, Montreal, Quebec, Canada.
Inflamm Bowel Dis. 2022 Feb 1;28(2):176-182. doi: 10.1093/ibd/izab092.
The specific contribution of anti-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.
Using the Regie de l'Assurance Maladie du Québec, we identified incident cases of IBD between 1998 and 2015. We 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 nonuse as the comparator. We conducted conditional logistic regression to estimate odds ratios (ORs) with 95% confidence intervals (CIs), adjusting for potential confounders.
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 per 1000 person-years). Relative to nonuse, 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).
Use of anti-TNF therapy was associated with an increased risk of HZ among patients with 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.
抗TNF治疗对炎症性肠病（IBD）患者带状疱疹（HZ）发病的具体影响仍不确定。因此，这项巢式病例对照研究的目的是探讨使用抗TNF治疗是否与HZ风险增加相关。
利用魁北克医疗保险局的数据，我们确定了1998年至2015年间IBD的新发病例。我们将HZ的IBD病例与多达10名无HZ的IBD对照在队列进入年份和随访方面进行匹配。当前使用定义为索引日期前60天的抗TNF治疗处方，以未使用作为对照。我们进行条件逻辑回归以估计比值比（OR）及95%置信区间（CI），并对潜在混杂因素进行调整。
该队列包括15454例IBD新发病例。在平均5.0年的随访中，824例患者被诊断为HZ（发病率为每1000人年9.3例）。与未使用相比，当前使用抗TNF治疗与HZ总体风险增加相关（OR，1.5；95%CI，1.1 - 2.1）。50岁以上人群（OR，2.1；95%CI，1.2 - 3.6）以及同时使用类固醇和免疫抑制剂的人群（OR，4.1；95%CI，2.3 - 7.2）风险增加。
IBD患者使用抗TNF治疗与HZ风险增加相关，尤其是50岁以上人群和联合治疗患者。对于开始治疗的年轻IBD患者，应考虑HZ的预防策略。
