Immunosuppressive medication use and risk of herpes zoster (HZ) in patients with systemic lupus erythematosus (SLE): A nationwide case-control study

Hu, Stephen Chu‐Sung; Yen, Feng‐Lin; Wang, Tsu‐Nai; Lin, Yu-Chih; Lin, Chi-Ling; Chen, Gwo‐Shing

doi:10.1016/j.jaad.2015.12.059

Cited by 32 publications

(23 citation statements)

References 33 publications

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“…The concomitant use of corticosteroids and immunosuppressive agents agents are regarded as triggering factors for VZV infection, and this infection is more frequent among patients with no or low SLE disease activity [44]. The prevalence of herpes zoster in SLE has increased, and risk of herpes zoster is associated with lymphopenia, increased use of corticosteroids, and most types of immunosuppressive therapy [45-47]. A poor cellular immunity, including decreased IFN-γ releasing cells and CD4+ T cells in response to VZV, is correlated with VZV infection and SLE [48].…”

Section: Infection As a Vulnerable Point In Slementioning

confidence: 99%

Infection in systemic lupus erythematosus, similarities, and differences with lupus flare

Jung

Suh

2017

Korean J Intern Med

109

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Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse manifestations, and its pathogenesis is unclear and complicated. Infection and SLE are similar in that they both cause inf lammatory reactions in the immune system; however, one functions to protect the body, whereas the other is activated to damage the body. Infection is known as one of the common trigger factors for SLE; there are a number of reports on infectious agents that provoke autoimmune response. Several viruses, bacteria, and protozoa were revealed to cause immune dysfunction by molecular mimicry, epitope spreading, and bystander activation. In contrast, certain pathogens were revealed to protect from immune dysregulation. Infection can be threatening to patients with SLE who have a compromised immune system, and it is regarded as one of the common causes of mortality in SLE. A clinical distinction between infection and lupus f lare up is required when patients with SLE present fevers. With a close-up assessment of symptoms and physical examination, C-reactive protein and disease activity markers play a major role in differentiating the different disease conditions. Vaccination is necessary because protection against infection is important in patients with SLE.

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Section: Infection As a Vulnerable Point In Slementioning

confidence: 99%

Infection in systemic lupus erythematosus, similarities, and differences with lupus flare

Jung

Suh

2017

Korean J Intern Med

109

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“…SLE is characterized by complement activation, autoantibody production, immune complex deposition and systemic inflammation [1,2]. SLE is characterized by complement activation, autoantibody production, immune complex deposition and systemic inflammation [1,2].…”

Section: Introductionmentioning

confidence: 99%

“…Systemic lupus erythematosus (SLE) is a severe, chronic, systemic and inflammatory disease that potentially affects multiple organs and tissues. SLE is characterized by complement activation, autoantibody production, immune complex deposition and systemic inflammation [1,2]. Approximately 17-48/100 000 people worldwide suffer from SLE, and lupus could damage their immune system by the direct action of antibodies that influence physical and mental health, as well as quality of life and life expectancy in patients [3,4].…”

Section: Introductionmentioning

confidence: 99%

Association of interleukin 22 gene polymorphisms and serum IL-22 level with risk of systemic lupus erythematosus in a Chinese population

Wang

Zeng

Qin

et al. 2018

Clinical and Experimental Immunology

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The aim of this study was to investigate the association between the single-nucleotide polymorphisms (SNPs) of the interleukin 22 (IL-22) gene and systemic lupus erythematosus (SLE) in a Chinese population. Three IL-22 SNPs (rs2227485, rs2227513 and rs2227491) were genotyped using SNaPshot SNP genotyping assays and identified by sequencing in 314 SLE patients and 411 healthy controls. The IL-22 level of serum was assessed by enzyme-linked immunosorbent assay (ELISA) kits. Data were analysed by spss version 17.0 software. We found that rs2227513 was associated with an increased risk of SLE [AG versus AA: adjusted odds ratio (aOR) = 2·24, 95% confidence interval (CI) = 1·22-4·12, P = 0·010; G versus· A: adjusted OR = 2·18, 95% CI = 1·20-3·97, P = 0·011]. Further analysis in patients with SLE showed that the AG genotype and G allele were associated with an increased risk of renal disorder in SLE (G versus A: aOR = 3·09, 95% CI = 1·30-7·33, P = 0·011; AG versus· AA: aOR = 3·25, 95% CI = 1·35-7·85, P = 0·009). In addition, the concentration of IL-22 was significantly lower in the rs2227513 AG genotype compared with AA genotype (P = 0·028). These results suggest that rs2227513 polymorphism might contribute to SLE susceptibility, probably by decreasing the expression of IL-22.

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“…Among patients with SLE, risk factors identified for HZ infection included high-dose glucocorticoid (GC) and non-GC immunosuppressive therapies, 4,17,[19][20][21][22][23] increasing age, 4 lymphopenia, 20 glomerulonephritis 15,19,[21][22][23] or other major organ diseases, 19,21,24 co-morbidities such as diabetes mellitus, renal insufficiency, HIV infection and malignancies, 21,22 reduced functional status 4 and the presence of certain autoantibodies (anti-Ro/Sm/nRNP). 15,21 However, owing to the difference in study design, sample size, patient selection and method of analyses, these risk factors are inconsistent across studies. Although HZ reactivation is more frequent during the initial presentation of SLE, 20,24 it has also been reported in those with low disease activity not receiving heavy immunosuppression during the later course of the disease.…”

Section: Sle and Herpes Zoster Reactivationmentioning

confidence: 99%

Herpes zoster vaccination in systemic lupus erythematosus: the current status

Mok

2018

Human Vaccines & Immunotherapeutics

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Among the inflammatory rheumatic diseases, SLE is associated with the highest risk of herpes zoster reactivation relative to age. The reported incidence of herpes zoster infection in SLE ranges from 6.4 to 91.4/1000 patient-years, with main risk factors being major organ disease, immunosuppressive and biological therapies. Although herpes zoster in SLE is manageable with anti-viral treatment, complications such as superimposed bacterial infection, post-herpetic neuralgia may ensue. The low rate of herpes zoster vaccination in SLE is related to the lack of awareness, fear of the risk of vaccine-induced infection and disease flare, cost, as well as the lack of explicit recommendations of vaccine use for the paucity of data in immunocompromised and younger subjects. The recent availability of the non-live subunit and inactivated herpes zoster vaccines has provided more opportunities for SLE patients to be protected against this viral infection. More clinical trials are clearly needed in SLE to confirm safety, immunogenicity and efficacy of the herpes zoster vaccines.

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Immunosuppressive medication use and risk of herpes zoster (HZ) in patients with systemic lupus erythematosus (SLE): A nationwide case-control study

Cited by 32 publications

References 33 publications

Infection in systemic lupus erythematosus, similarities, and differences with lupus flare

Infection in systemic lupus erythematosus, similarities, and differences with lupus flare

Association of interleukin 22 gene polymorphisms and serum IL-22 level with risk of systemic lupus erythematosus in a Chinese population

Herpes zoster vaccination in systemic lupus erythematosus: the current status

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