Nitzan Itay, Shemesh Nadav, Kubovsky Shoham, Shalmov Tehila, Levy Jaime, Amer Radgonde
From the Department of Ophthalmology (I.N., N.S., S.K., T.S., J.L., R.A.), Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
From the Department of Ophthalmology (I.N., N.S., S.K., T.S., J.L., R.A.), Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Am J Ophthalmol. 2025 Sep;277:213-220. doi: 10.1016/j.ajo.2025.05.019. Epub 2025 May 23.
To evaluate the long-term risk of incident giant cell arteritis (GCA) following herpes zoster ophthalmicus (HZO).
Retrospective cohort study.
Adults aged ≥50 years with a diagnosis of HZO (ICD-10 B02.3) between May 2005 and April 2024 were identified from the TriNetX Global Collaborative Network and compared to controls without any history of zoster. All patients had ≥6 months of data before and after the index date. Individuals with prior diagnoses of GCA, polymyalgia rheumatica, HIV, or transplant status were excluded.
Propensity score matching (PSM) was applied in a 1:1 ratio to balance baseline characteristics. Time-to-event analysis was performed using a Cox proportional hazards model and a log-rank test, with cumulative incidence illustrated by a Kaplan-Meier curve. Sensitivity analyses evaluated the impact of antiviral therapy and prior zoster vaccination.
Incident GCA (ICD-10 M31.5 or M31.6), assessed beginning 30 days after index diagnosis. The E-value was calculated to assess robustness against unmeasured confounding.
After matching, 18 154 patients were included in each cohort (mean age, 66.6 years; 57.5% female). During 10 years of follow-up, GCA occurred in 42 HZO patients and 14 controls, corresponding to incidence rates of 49.9 vs 16.2 per 100 000 person-years (log-rank P < .001). HZO was associated with a more than threefold increased risk of GCA (HR, 3.09; 95% CI, 1.69-5.65). The E-value was 5.63 for the HR and 2.77 for the lower confidence limit. In sensitivity analyses, antiviral therapy initiated within 7 days of HZO diagnosis was not associated with a reduced risk of GCA (HR, 0.86; 95% CI, 0.43-1.68), and herpes zoster vaccination administered ≥1 month before HZO diagnosis showed no protective association (HR, 1.60; 95% CI, 0.55-4.66).
In this large real-world cohort, HZO was associated with an increased risk of incident GCA, although the absolute risk remained low. Further research is needed to clarify pathophysiologic mechanisms and the potential impact of antiviral or vaccine-based interventions.
评估眼部带状疱疹（HZO）后发生巨细胞动脉炎（GCA）的长期风险。
回顾性队列研究。
从TriNetX全球合作网络中识别出2005年5月至2024年4月期间诊断为HZO（国际疾病分类第十版B02.3）的≥50岁成年人，并与无带状疱疹病史的对照进行比较。所有患者在索引日期前后均有≥6个月的数据。排除先前诊断为GCA、风湿性多肌痛、HIV或有移植状态的个体。
采用倾向评分匹配（PSM）以1:1的比例平衡基线特征。使用Cox比例风险模型和对数秩检验进行事件发生时间分析，累积发病率用Kaplan-Meier曲线表示。敏感性分析评估抗病毒治疗和先前带状疱疹疫苗接种的影响。
索引诊断后30天开始评估发生的GCA（国际疾病分类第十版M31.5或M31.6）。计算E值以评估对未测量混杂因素的稳健性。
匹配后，每个队列纳入18154例患者（平均年龄66.6岁；57.5%为女性）。在10年的随访期间，42例HZO患者和14例对照发生了GCA，发病率分别为每10万人年49.9例和16.2例（对数秩P<.001）。HZO与GCA风险增加三倍以上相关（风险比[HR]，3.09；95%置信区间[CI]，1.69 - 5.65）。HR的E值为5.63，下限置信区间的E值为2.77。在敏感性分析中，HZO诊断后7天内开始的抗病毒治疗与GCA风险降低无关（HR，0.86；95%CI，0.43 - 1.68），在HZO诊断前≥1个月接种的带状疱疹疫苗未显示出保护关联（HR，1.60；95%CI，0.55 - 4.66）。
在这个大型真实世界队列中，HZO与发生GCA的风险增加相关，尽管绝对风险仍然较低。需要进一步研究以阐明病理生理机制以及抗病毒或基于疫苗的干预措施的潜在影响。
