番茄社区

ORLANDO -- While patients with inflammatory bowel disease (IBD) are historically more prone to herpes zoster attacks, those who received recombinant zoster vaccines had a far lower risk of the painful rash emerging, researchers reported here.

In a retrospective cohort study of IBD patients ages 50 and older, there was a lower risk of a herpes zoster attack in the patients who received the vaccine versus those who did not over a 3-year follow-up (adjusted OR 0.44, 95% CI 0.32-0.62), reported Aakash Desai, MD, of the Mayo Clinic in Jacksonville, Florida, during a poster presentation at the Advances in Inflammatory Bowel Diseases annual meeting.

These results were similar for those with ulcerative colitis (aOR 0.41, 95% CI 0.27-0.63) or Crohn's disease (aOR 0.44, 95% CI 0.26-0.74), Desai said.

While the overall risk of herpes zoster attacks was markedly reduced, when Desai and colleagues looked specifically at cases in which there were serious complications -- neurological complications, ocular complications, and disseminated zoster, as well as post-herpetic neuralgia -- there did not appear to be a statistically significant difference. Complicated zoster was observed in 13 patients in the vaccine group compared with 10 patients in the control group (aOR 1.35, 95% CI 0.55-3.26), and post-herpetic neuralgia was observed in 21 and 22 patients, respectively (aOR 0.94, 95% CI 0.47-1.86).

Commenting on the study, Oscar Ardila, MD, of CES University in Medellín, Colombia, told 番茄社区, "This is an expected result. The study shows that the shingles vaccine prevents about half the cases of zoster among people with inflammatory bowel disease. The main impact is the reduction in regular or mild cases of shingles, but there was no statistically significant difference in preventing the more serious cases of shingles in these patients."

"But you have to realize that these severe cases with bad complications are uncommon, and in order to show a statistical difference in preventing these cases, your study population would have to be far larger than in this study," he added. "While this study doesn't show there is a difference in these more difficult cases, the reduction in the milder cases is still very important to the patients -- even these cases can cause 1 to 2 weeks of pain and discomfort -- and to the healthcare system."

For this study, Desai and colleagues used data from TriNetX, a multi-institutional database of 60 centers across the U.S. from January 2018 to June 2023. They identified 5,265 patients ages 50 and older with IBD using ICD-10 hospital codes, who had received IBD-specific medication and two doses of the herpes zoster vaccine. They also included 5,265 control patients using propensity score matching.

Of the total cohort, mean age was 63 years, 57.2% were women, and 82.9% were white; 52.8% had ulcerative colitis. The vaccinated population were followed for a mean 900.9 days, while the control population was followed for a mean 846.3 days.

The effectiveness in preventing zoster outbreaks was observed across a series of subgroups, Desai reported, including those younger than 65 and those 65 and older; those who had diabetes or lung diseases; and those on immunosuppressive therapy or chronic steroids.

Visits to the emergency department were also similar between the groups, with 12 vaccinated patients having visits over a 3-year follow-up compared with 19 in the control group (aOR 0.57, 95% CI 0.26-1.26).

Desai and team noted that future studies need to assess long-term outcomes in patients ages 18 to 49.

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