Recombinant Zoster Vaccine (RZV) is Effective in Reducing Herpes Zoster Infection in Patients With Inflammatory Bowel Disease: A US Propensity Matched Cohort Study
AIBD 2023
Background:
Recombinant zoster vaccine (RZV) has been shown to reduce the short-term risk of herpes zoster (HZ) in patients with inflammatory bowel disease (IBD). However, there is lack of data regarding the long-term efficacy in this population.
Methods:
A retrospective cohort study was conducted in adults >= 50 years old using TriNetX, a multi-institutional prospectively maintained database between patients with IBD who received 2 doses of RZV (IBD-RZV cohort) and patients who did not receive RZV (IBD control cohort). The primary outcome of the study was risk of incident HZ within 3 years. The secondary outcomes included risk of complicated HZ (encephalitis, meningitis, ocular disease or disseminated zoster) and post-herpetic neuralgia (PHN); and risk of HZ in patients on immunosuppressive therapy (IT) and chronic corticosteroid use. One-to-one (1:1) propensity score matching (PSM) was performed for demographic parameters, co-morbid conditions and IBD medications. Risk was expressed as adjusted odds ratio (aOR) with 95% confidence intervals (CI).
Results:
There were 5489 patients in the IBD-RZV cohort (mean age 63.2 +/- 9.1 years old, 57.2% females and 47.2% Crohn’s disease) with a mean follow up of 900.9 days. After PSM, IBD-RZV cohort had a lower risk of HZ (aOR 0.44, 95% CI 0.32-0.62) compared to IBD control cohort. The risk of HZ was lower in patients aged 50-65 years old (aOR 0.41, 95% CI 0.25-0.68) and patients > 65 years old (aOR 0.64, 95% CI 0.42-0.96). There was a lower risk of HZ in patients with UC (aOR 0.41, 95% CI 0.27-0.63) and CD (aOR 0.44, 95% CI 0.26-0.74) in the IBD-RZV cohort. There was no difference in the risk of complicated zoster (aOR 1.35, 95% CI 0.55-3.26) and PHN (aOR 0.94, 95% CI 0.47-1.86) between the IBD-RZV and IBD control cohort. Risk of HZ was also lower in the IBD-RZV cohort compared to IBD control cohort on IT (aOR 0.61, 95% CI 0.38-0.97) and chronic corticosteroids (0.42, 95% CI 0.20-0.88).
Conclusions:
RZV is associated with a lower long-term risk of HZ in patients with IBD age ≥ 50 years old. Given the widespread availability and safety of RZV, more effective vaccination strategies are needed to improve RZV utilization in this high-risk population.
