Session Type: Poster Session (Tuesday)
Session Time: 9:00AM-11:00AM
Background/Purpose: To study the prevalence of Herpes Zoster (HZ) reactivation in patients with biopsy confirmed lupus nephritis (LN) undergoing immunosuppressive therapies.
Methods: Patients who had biopsy confirmed active LN (2003-2018) were retrospectively reviewed for the occurrence of HZ infection. The following data were collected: age, sex, SLE disease activity scores, maximum daily dose and total duration of high-dose prednisolone and other immunosuppressive drugs in the induction period, maintenance therapies, laboratory parameters at baseline and 6 months post-therapy that included lupus serology, albumin, globulin, IgG/A/M levels, white cell counts, histological classes of LN and renal response. The incidence of HZ reactivation at 2 years of LN treatment and on follow-up was calculated. Risk factors for HZ reactivation were studied by logistic regression.
Results: 251 patients with 311 episodes of active LN were studied (92% women; age 34.2±14.2 years). Histological LN classes were: III/IV±V(69%), I/II/V/VI(31%). Induction regimens were: moderate/high dose prednisolone in combination with cyclophosphamide (17%), azathioprine (11%), mycophenolate mofetil (MMF) (42%), tacrolimus (25%). Renal response at 6m was: complete response (CR) (59%), partial response (PR) (27%) and non-response (NR) (15%). Within 2 years of therapies, 55(18%) episodes of LN were complicated by HZ infection (incidence: 8.84/100 patient-year). The median time for HZ reactivation since LN therapy was 11 months. 28 patients had HZ infection beyond 2 years (overall prevalence: 3.24/100 patient-years). The distribution of HZ lesions was: head and neck (15%), lower limbs (27%), trunk (55%) and upper limbs (4%). 75% of the episodes were treated by oral acyclovir. Secondary bacterial infection or significant neuralgia occurred in 18% of the episodes. Disseminated disease or mortality was not reported. Patients with HZ reactivation were more likely to have first-time renal disease (76% vs 58%; p=0.02) and a shorter SLE duration at LN (31.4±50 vs 62.7±72 months; p=0.02). A trend of higher SLEDAI, higher anti-dsDNA, lower C3/albumin but more refractory disease was observed in HZ-infected patients. Histological LN classes, neutrophil/lymphocyte counts and immunoglobulin levels at baseline and 6 months post-therapy were not significantly different between HZ-infected and control patients. HZ-infected patients had been treated with a significantly higher dose of prednisolone (0.72±0.40 vs 0.63±0.24 mg/kg/day) at induction. Higher doses of other immunosuppressive drugs had also been used in patients with HZ reactivation but the difference was not statistically significant. Logistic regression revealed first-time LN (OR 2.25[1.08-4.71]; p=0.003), peak MMF dose (OR 1.24[1.10-3.07]; p=0.02) and cumulative CYC dose (OR 1.14[1.01-1.28]; p=0.04) during induction therapy were significantly associated with HZ at 2 years.
Conclusion: HZ reactivation is fairly common in LN patients undergoing immunosuppressive therapies but unpredictable from clinical parameters. Minimization of immunosuppression and HZ vaccination may help reduce the risk of HZ infection.
To cite this abstract in AMA style:Mok C, Chan K, Tse S, Ho L. Prevalence and Risk Factors of Herpes Zoster Reactivation in Patients with Biopsy Proven Lupus Nephritis Undergoing Immunosuppressive Therapies [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/prevalence-and-risk-factors-of-herpes-zoster-reactivation-in-patients-with-biopsy-proven-lupus-nephritis-undergoing-immunosuppressive-therapies/. Accessed June 5, 2020.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-and-risk-factors-of-herpes-zoster-reactivation-in-patients-with-biopsy-proven-lupus-nephritis-undergoing-immunosuppressive-therapies/