P048 Herpes Zoster Incidence in Patients with Systemic Lupus Erythematosus: A Retrospective Cohort Study
Authors: Stempniewicz Nikita , Steffens Andrea , Kim Kimvi , Jorga Anamaria , Bell Christopher F , DuCharme Mary , Trenz Helen , Singer David , Odedra Heena 
Published: April 2024

Abstract

Background/Aims
Herpes zoster (HZ) results from reactivation of the varicella-zoster virus and is characterized by a painful dermatomal rash. HZ is associated with increased healthcare costs and reduced patient quality of life. Objectives: To estimate HZ incidence in patients with systemic lupus erythematosus (SLE) and in a general immunocompetent adult population in the United States.

Methods
This retrospective cohort study used administrative claims data (Optum Research Database) to identify adults (≥18 years) between October 2015 and May 2022 who were assigned to one of two cohorts based on ICD-10-CM diagnosis codes: SLE cohort and immunocompetent cohort. Patients with diagnosis codes for other immunocompromising conditions (ICC) were excluded from the immunocompetent cohort and from the main SLE cohort to create a sub-cohort (SLE without other ICC). The immunocompetent cohort represented a random sample of one million individuals meeting the cohort criteria. Indexing occurred at the later of 12 months of continuous enrollment (CE) or the first SLE diagnosis for the SLE cohorts, and after 12 months of CE for the immunocompetent cohort. Patients with HZ vaccination prior to index or a HZ diagnosis in the 12-month baseline period were excluded. Patients were followed for a variable period from index until the earlier of an incident HZ diagnosis or censoring event (HZ vaccination, disenrollment, death, or the end of the study period). Overall incidence rates of HZ were estimated in each cohort and stratified by age at index, and by baseline disease severity for the SLE cohorts using a published algorithm.

Results
The SLE cohort included 60,430 patients, among which 21,206 comprised the SLE without other ICC cohort. The immunocompetent cohort included 1,000,000 patients. Mean (standard deviation) age and percent female for the SLE (55 [15] years; 89% female) and for the SLE without other ICC (53 [16] years; 89% female) cohorts were higher compared to the immunocompetent (46 [18] years; 50% female) cohort (p &lt; 0.001). For the SLE cohort, HZ incidence (95% confidence interval [CI]) per 1,000 person-years was 19.72 (18.93-20.55) overall and 16.27 (15.04-17.58) and 21.50 (20.48-22.56) per 1,000 person-years for patients aged 18-49 and ≥50 years, respectively. HZ incidence (95% CI) for the SLE without other ICC cohort was 14.03 (12.83-15.32) per 1,000 person-years overall (18-49 years: 11.24 [9.61-13.07]; ≥50 years: 16.08 [14.39-17.91]). HZ incidence (95% CI) for the immunocompetent cohort was 5.64 (5.53-5.74) per 1,000 person-years (18-49 years: 3.46 [3.35-3.57]; ≥50 years: 8.57 [8.37-8.77]). HZ incidence rates in the SLE cohorts increased with baseline disease severity.

Conclusion
HZ incidence was high among patients with SLE. HZ prevention strategies in this population may be warranted.

Disclosure
N. Stempniewicz: Corporate appointments; N.S. is an employee of GSK. Shareholder/stock ownership; N.S. is a shareholder of GSK. A. Steffens: Consultancies; A.S. is a consultant of GSK. K. Kim: Corporate appointments; K.K. is an employee of GSK. A. Jorga: Corporate appointments; A.J. is an employee of GSK. Shareholder/stock ownership; A.J. is a shareholder of GSK. C.F. Bell: Corporate appointments; C.F.B. is an employee of GSK. Shareholder/stock ownership; C.F.B. is a shareholder of GSK. M. DuCharme: Consultancies; M.D. is a consultant of GSK. H. Trenz: Consultancies; H.T. is a consultant of GSK. D. Singer: Corporate appointments; D.S. is an employee of GSK. Shareholder/stock ownership; D.S. is a shareholder of GSK. H. Odedra: Corporate appointments; H.O. is an employee of GSK. Other; H.O. is the presenter on behalf of the authors.