FRI0146 Incidence Rate and The Risk of Herpes Zoster in Patients with Rheumatoid Arthritis Using Japanese Health Insurance Database
Authors: R. Sakai, S. Kasai, F. Hirano, M. Kihara, W. Yokoyama, M. Tsutsumino, K. Nagasaka, R. Koike, H. Yamanaka, N. Miyasaka, M. Harigai
Journal: Annals of the Rheumatic Diseases (2016)

<h3>Background</h3> A high risk of herpes zoster (HZ) in patients with rheumatoid arthritis (RA) has been reported<sup>1</sup>. The risk of HZ in Asian patients, especially Japanese, on tofacitinib was higher than that of Western countries <sup>2</sup>. It is essential for rheumatologists to diagnose and manage HZ early not only to prevent post-herpetic neuralgia but also hamper developing cutaneous dissemination and visceral end organ involvement. However, there are no reports investigating the incidence rate (IR) and risk of HZ in RA patients using large population-based data in Asia. <h3>Objectives</h3> To compare the IR of HZ between RA cases and non-RA cases, and estimate the risk of HZ during three years using Japanese health insurance database. <h3>Methods</h3> This retrospective longitudinal population-based study was conducted using claims data provided by the Japan Medical Data Center Co., Ltd. We defined individuals as RA cases if they met all of the following: 1) had at least 6 months of continuous enrollment in the health insurance database; 2) had at least one RA diagnostic code (ICD10 codes; M05, M060, M062, M063, M068, and M069); 3) had at least one prescription of disease-modifying antirheumatic drugs (DMARDs) between January 2005 and December 2013; and 4) were 18 years old or older (RA group, n=6,712). Among individuals who met above criteria 1), but did not meet 2) to 4), we selected age- (±5 years), gender-, calendar year of the observation start, and observation length-matched non-RA cases at 1:5 ratio (RA cases: non-RA cases) (non-RA group, n=33,560). The start of the observation in the RA group was defined by the month of the first prescription of DMARDs with RA diagnostic code after the first 6 months of the enrollment in the health insurance database. Observation stopped either 3 years after the start of the observation, or on the month individuals withdrew from the health insurance or on December 2014, whichever came first. Patients who had the ICD 10 codes for HZ (B02) and were prescribed antivirus drugs for HZ at least one time during observation term were deemed as developing HZ. We compared the IR of HZ between the two groups and investigated the association between RA and HZ using conditional logistic regression analysis. <h3>Results</h3> The median age was 52, and 75.6% were female in the both groups. Biological DMARDs were prescribed in 13.9% of RA cases, methotrexate in 58.3%, synthetic DMARDs other than methotrexate in 46.9%, and oral corticosteroids in 35.0% at baseline. The IR of HZ in the RA group [14.1/1,000 person-years (PY)] was significantly higher than that of the non-RA group (8.3/1,000 PY). The odds ratio [95% confidence interval] of RA for HZ was 1.5 [1.2–1.8] after adjusting for past history of HZ, pulmonary and renal comorbidities at baseline, and use of oral corticosteroids at baseline. <h3>Conclusions</h3> This study revealed that patients with RA had significantly higher risk of HZ than non-RA individuals using health insurance database for the first time in Asia. <h3>References</h3> Arthritis Care Res, 2013;65:854–861 Arthritis Rheum, 2014:66:2675–84 Arthritis Res Ther, 2009;11:229 Arthritis Rheum, 2005;53:241–248 <h3>Acknowledgement</h3> This work was supported by the research grant from the Ministry of Health, Labour, and Welfare, Japan. <h3>Disclosure of Interest</h3> R. Sakai Grant/research support from: Abbvie Japan Co. Ltd., Astellas Pharma Inc., Bristol Meyears Squibb, Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma Corp., Takeda Pharmaceutical Co. Ltd., and UCB Japan, S. Kasai: None declared, F. Hirano: None declared, M. Kihara: None declared, W. Yokoyama: None declared, M. Tsutsumino Grant/research support from: Abbvie Japan Co. Ltd., Astellas Pharma Inc., Bristol Meyears Squibb, Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma Corp., Takeda Pharmaceutical Co. Ltd., and UCB Japan, K. Nagasaka Grant/research support from: Abbvie Japan Co. Ltd., Astellas Pharma Inc., Bristol Meyears Squibb, Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma Corp., Takeda Pharmaceutical Co. Ltd., and UCB Japan, R. Koike: None declared, H. Yamanaka Grant/research support from: Chugai Pharmaceutical Co. Ltd., Astellas Pharma Inc., Bristol-Meyers Squibb, AbbVie Japan Co. Ltd., Daiichi-Sankyo, Mitsubishi-Tanabe Pharma Corp., Takeda Pharmaceutical Co. Ltd., UCB Japan, Consultant for: Chugai Pharmaceutical Co. Ltd., Astellas, Bristol-Meyers Squibb, AbbVie Japan Co. Ltd., Daiichi-Sankyo, Mitsubishi-Tanabe Pharma Corp., Takeda Pharmaceutical Co. Ltd., UCB Japan, N. Miyasaka: None declared, M. Harigai Grant/research support from: Abbvie Japan Co. Ltd., Astellas Pharma Inc., Bristol Meyears Squibb, Chugai Pharmaceutical Co. Ltd., Eisai Co. Ltd., Mitsubishi Tanabe Pharma Corp., Takeda Pharmaceutical Co. Ltd., UCB Japan, Pfizer Japan Inc., Sanofi-Aventis KK., Santen Pharmaceutical Co., Ltd and Sekisui Medical Co., Ltd