@article{471521ef767445ad97001013e29eb7f6,
title = "Herpes zoster in immunocompromised patients: Incidence, timing, and risk factors",
abstract = "PURPOSE: To evaluate the risk factors for herpes zoster as well as the incidence and timing of this complication in patients who were treated with immunosuppression because of active Wegener's granulomatosis. SUBJECTS AND METHODS: We studied the 180 Wegener's granulomatosis patients in the Wegener's Granulomatosis Etanercept Trial (WGET). Herpes zoster events during WGET were documented prospectively. Follow-up questionnaires were employed to describe the location, treatment, and complication(s) of herpes zoster and its therapy. Univariate and multivariate analyses were performed to evaluate risk factors, including history of herpes zoster, for the occurrence of herpes zoster during the trial. All analyses were based on the time to first occurrence of herpes zoster. RESULTS: Eighteen patients (10% of the WGET cohort) suffered a total of 19 herpes zoster episodes over a mean follow-up period of 27 months. The annual incidence of herpes zoster in the WGET cohort was 45 cases/1000 patient-years (95% confidence interval [CI]: 27, 70). The median time from enrollment to the occurrence of herpes zoster in the subgroup of patients with that complication was 16.5 months (± 9.4). Fifteen of the 19 herpes zoster events (79%) occurred between months 6 and 36, many months after the period of most intensive immunosuppression. In univariate analyses, history of serum creatinine <1.5 mg/dL before enrollment was associated with a relative risk (RR) of 3.0 (95% CI: 1.1, 7.8) for herpes zoster during WGET (P = .03). In multivariate analyses, serum creatinine <1.5 mg/dL was associated with an RR of 6.3 (95% CI: 2.0, 19.8; P = .002), and female sex with an RR of 4.6 (95% CI: 1.6, 13.2; P = .004). CONCLUSION: Renal dysfunction and female sex were consistently strong risk factors for herpes zoster events in this population. Contrary to expectation, most herpes zoster events did not occur during periods of most intensive immunosuppression. These data may inform studies of interventions designed to prevent herpes zoster in patients on treatment for immune-mediated diseases.",
keywords = "Herpes zoster, Immunosuppression, Incidence, Renal insufficiency, Wegener's granulomatosis",
author = "Wung, {Peter K.} and Holbrook, {Janet T.} and Hoffman, {Gary S.} and Tibbs, {Andrea K.} and Ulrich Specks and Min, {Y. I.} and Merkel, {Peter A.} and Robert Spiera and Davis, {John C.} and {St. Clair}, {E. William} and Joseph McCune and Ytterberg, {Steven R.} and Allen, {Nancy B.} and Stone, {John H.}",
note = "Funding Information: Chairman The Johns Hopkins Vasculitis Center: John H. Stone, MD, MPH, Chairman Co-Chairman The Cleveland Clinic Foundation Center for Vasculitis Research and Care, Gary S. Hoffman, MD, Co-Chairman Coordinating Center The Johns Hopkins University Center for Clinical Trials: Janet T. Holbrook, PhD, MPH, Director Curtis L. Meinert, PhD, Associate Director John Dodge, Systems Analyst Jessica Donithan, Research Coordinator Nancy Min, PhD, Biostatistician Laurel Murrow, MSc, Trial Coordinator (former) Maria Oziemkowska, MPH (former) Jacki Smith, Research Data Assistant Andrea K. Tibbs, BS, Trial Coordinator Mark Van Natta, MHS, Biostatistician Clinical Centers The Beth Israel Medical Center, New York: Robert Spiera, MD Iresha Abeynayake, MPH Rosanne Berman, MPH Sandy Enuha, MPH Boston University: Peter A. Merkel, MD, MPH Rondi Gelbard, BS Melynn Nuite, RN Aileen Schiller, MS The Cleveland Clinic Foundation: Gary S. Hoffman, MD, MS David Blumenthal, MD Debora Bork, MFA Tiffany Clark, CNP Sonya L. Crook, RN Leonard H. Calabrese, DO Sharon Farkas Sudhakar Sridharan, MD Kimberly Strom, CNP William Wilke, MD Duke University: E. William St. Clair, MD Nancy B. Allen, MD Karen Rodin, RN Edna Scarlett Johns Hopkins University: John H. Stone, MD, MPH David B. Hellmann, MD Matthew A. Marriott, PA-C Amanda M. Moore, BS Lourdes Pinachos, RN, BSN Michael J. Regan, MD, MRCP Misty L. Uhlfelder, MPH The Mayo Clinic: Ulrich Specks, MD Kristin Bradt Kimberly Carlson Susan Fisher, RN Boleyn Hammel Kathy Mieras Steven Ytterberg, MD University of California, San Francisco: John C. Davis, MD, MPH Anne Marie Duhme, BSN Maureen Fitzpatrick, MPH Ken Fye, MD Steve Lund, MSN, NP University of Michigan: Joseph McCune, MD Billie Jo Coomer, BS Barbara Gilson, RN Hilary Haftel, MD Ana Morrel-Samuels, BA Sandra Neckel, RN Resource Centers The Johns Hopkins University Immune Diseases Laboratory: Noel R. Rose, MD, PhD C. Lynne Burek, PhD Jobert Barin, BS Monica Talor, MS Data and Safety Monitoring Board Paul L. Canner, PhD, Maryland Medical Research Institute Doyt L. Conn, MD, Emory University (Safety Officer) John H. Klippel, MD, Arthritis Foundation (Chair) J. Richard Landis, PhD, University of Pennsylvania ",
year = "2005",
month = dec,
doi = "10.1016/j.amjmed.2005.06.012",
language = "English (US)",
volume = "118",
pages = "1416.e9--1416.e18",
journal = "American Journal of Medicine",
issn = "0002-9343",
publisher = "Elsevier Inc.",
number = "12",
}