Background/Purpose: Disseminated zoster is a highly morbid complication of varicella zoster reactivation (herpes zoster) that is typically associated with immunosuppression. Systemic lupus erythematosus (SLE) and lupus nephritis (LN) are associated with increased risk of herpes zoster [1,2] but rates of disseminated zoster in these populations have not been described. The objective of this study was to compare the rates of herpes zoster and disseminated zoster infections in patients with SLE and LN using population-based claims data.

Methods: We conducted a retrospective cohort study using the Truven Healthcare MarketScan^® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits database between 2000 and 2014. Patients with SLE (SLE cohort) and SLE and LN (LN cohort) were identified using modifications to validated algorithms using claims data [3,4]. All patients received medical care in the U.S. and had 6 months of continuous medical and drug coverage ± index date. End of study was the first of end of enrollment or end of database. Incident herpes zoster cases were identified using ICD-9 codes 053.xx. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated.

Results: SLE and LN cohorts included 76,354 and 11,068 patients, respectively. Mean age was 48.1 and mean enrollment duration was 6.3 years. For patients in the SLE cohort there were 4284 incident cases of herpes zoster, of which 582 (14%) were considered disseminated. The LN cohort had increased rates of herpes zoster (IRR 1.6, 95% CI 1.5 to 1.7) and disseminated zoster (IRR 1.9, 95% CI 1.6 to 2.3) compared with the SLE cohort (Table 1).

Conclusion: In this population-based analysis of claims data, the rate of herpes zoster in SLE was consistent with prior reports [1] and the presence of LN was associated with increased risk of herpes zoster and disseminated zoster compared with SLE. A substantial minority of herpes zoster cases were associated with dissemination. Further characterization of the relative contributions of age, immunosuppressive therapies, and disease factors is warranted.

  1. Chakravarty EF et al. Lupus, 2013;22:238-44. 2. Chen D et al., Exp Ther Med, 2017;14:6222-8. 3. Chibnik LB et al. Lupus, 2010;19:741-3. 4. Arkema EV et al. BMJ open, 2016;6:e007769.