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Patients with inflammatory bowel disease on certain immunosuppressants have increased herpes zoster risk. Dr Long and colleagues from North Carolina, USA determined the risk of herpes zoster in inflammatory bowel disease, and how antitumor necrosis factor-alpha agents affect this risk. The team performed a retrospective cohort and nested case-control study using administrative data from IMS LifeLink Information Assets-Health Plan Claims Database. In the cohort, the team identified inflammatory bowel disease patients age 64 by diagnosis codes, matched to 4 individuals without inflammatory bowel disease. The doctors noted that the increased herpes zoster risk was evaluated by incidence rate ratio and adjusted Cox proportional hazards models. In the nested case-control analysis, 2659 inflammatory bowel disease patients with increased herpes zoster were each matched to 4 inflammatory bowel disease patients without increased herpes zoster. The research team determined associations between medications and increased herpes zoster using conditional logistic regression.  | | Risk of increased herpes zoster was highest with combination anti-TNF | | Alimentary Pharmacology & Therapeutics |
The cohort included 50,932 patients with Crohn's disease, 56,403 patients with ulcerative colitis, and 1269 with unspecified inflammatory bowel disease, matched to 434 416 individuals without inflammatory bowel disease. The doctors examined that the inflammatory bowel disease cohort had increased herpes zoster risk compared with non-inflammatory bowel disease. After adjustment, inflammatory bowel disease patients had a higher risk of increased herpes zoster than non-inflammatory bowel disease. The research team observed that in the nested case-control multivariate-adjusted analyses, anti-TNF medications, corticosteroids and thiopurines were independently associated with increased herpes zoster. Risk of increased herpes zoster was highest with combination anti-TNF and thiopurine therapy. Dr Long's team concludes, "Patients with inflammatory bowel disease are at increased risk for herpes zoster." "Use of thiopurines, anti-TNF agents, combination therapy and corticosteroids increases herpes zoster risk."
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