Risk of shingles in adults with primary Sjogren's syndrome and treatments: A nationwide population-based cohort study

Jen Yin Chen, Li Kai Wang, Ping Hsun Feng, Chin Chen Chu, Tain Junn Cheng, Shih Feng Weng, Su Zhen Wu, Tsung Hsueh Lu, Chia Yu Chang, Ilhem Messaoudi

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Abstract

Background Primary Sjögren's syndrome (pSS) is associated with immunological dysfunctions - a well-known risk factor of shingles. This study aimed to examine the incidence and risk of shingles in adults with pSS and pharmacological treatments. Methods This retrospective population-based cohort study was conducted using National Health Insurance claims data. Using propensity scores, 4,287 pSS adult patients and 25,722-matched cohorts by age, gender, selected comorbidities and Charlson comorbidity index scores were identified. Kaplan-Meier analysis and Cox regression were conducted to compare the differences in developing shingles. In pSS, oral and eye dryness are treated with substitute agents. Extraglandular features are often treated with pharmacological drugs including steroids and immunosuppressants. pSS patients were grouped as follows: no pharmacological drugs, steroids alone; immunosuppressants alone; combined therapies. Results During the follow-up, 463 adults with pSS (10.80%) and 1,345 control cohorts (5.23%) developed shingles. The cumulative incidence of shingles in pSS patients (18.74/1,000 patient-years) was significantly higher than controls (8.55/1,000 patient-years). The adjusted hazard ratio (HR) of shingles was 1.69 (95% confidence interval (CI) 1.50-1.90). In age-subgroup analyses, incidences of shingles in pSS increased with age and peaked in pSS patients aged ≥60; however, adjusted HRs decreased with age. Compared to control cohorts with no drugs, adjusted HRs for shingles in pSS patients were ranked from high to low as: combined therapies (4.14; 95% CI 3.14-5.45) > immunosuppressants alone (3.24; 95% CI 2.36-4.45) > steroids alone (2.54; 95% CI 2.16-2.97) > no pharmacological drugs (2.06; 95% CI 1.76-2.41). Rates of shingles-associated hospitalization and postherpetic neuralgia were 5.62% and 24.41%, both of which were significantly higher than those (2.60%; 13.01%) in the control cohorts. Conclusions Adults with pSS were at greater risk for shingles than control cohorts. Drug exposures significantly increased the risk of shingles in pSS.

Original languageEnglish
Article numbere0134930
JournalPloS one
Volume10
Issue number8
DOIs
Publication statusPublished - 2015 Aug 25

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Sjogren's Syndrome
Herpes Zoster
cohort studies
Cohort Studies
Immunosuppressive Agents
confidence interval
immunosuppressive agents
Pharmaceutical Preparations
Population
drugs
Steroids
steroids
Confidence Intervals
Health insurance
incidence
Therapeutics
Pharmacology
health insurance
therapeutics
Hazards

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Chen, J. Y., Wang, L. K., Feng, P. H., Chu, C. C., Cheng, T. J., Weng, S. F., ... Messaoudi, I. (2015). Risk of shingles in adults with primary Sjogren's syndrome and treatments: A nationwide population-based cohort study. PloS one, 10(8), [e0134930]. https://doi.org/10.1371/journal.pone.0134930
Chen, Jen Yin ; Wang, Li Kai ; Feng, Ping Hsun ; Chu, Chin Chen ; Cheng, Tain Junn ; Weng, Shih Feng ; Wu, Su Zhen ; Lu, Tsung Hsueh ; Chang, Chia Yu ; Messaoudi, Ilhem. / Risk of shingles in adults with primary Sjogren's syndrome and treatments : A nationwide population-based cohort study. In: PloS one. 2015 ; Vol. 10, No. 8.
@article{ccce577f6cd249909ece475cccf64ddd,
title = "Risk of shingles in adults with primary Sjogren's syndrome and treatments: A nationwide population-based cohort study",
abstract = "Background Primary Sj{\"o}gren's syndrome (pSS) is associated with immunological dysfunctions - a well-known risk factor of shingles. This study aimed to examine the incidence and risk of shingles in adults with pSS and pharmacological treatments. Methods This retrospective population-based cohort study was conducted using National Health Insurance claims data. Using propensity scores, 4,287 pSS adult patients and 25,722-matched cohorts by age, gender, selected comorbidities and Charlson comorbidity index scores were identified. Kaplan-Meier analysis and Cox regression were conducted to compare the differences in developing shingles. In pSS, oral and eye dryness are treated with substitute agents. Extraglandular features are often treated with pharmacological drugs including steroids and immunosuppressants. pSS patients were grouped as follows: no pharmacological drugs, steroids alone; immunosuppressants alone; combined therapies. Results During the follow-up, 463 adults with pSS (10.80{\%}) and 1,345 control cohorts (5.23{\%}) developed shingles. The cumulative incidence of shingles in pSS patients (18.74/1,000 patient-years) was significantly higher than controls (8.55/1,000 patient-years). The adjusted hazard ratio (HR) of shingles was 1.69 (95{\%} confidence interval (CI) 1.50-1.90). In age-subgroup analyses, incidences of shingles in pSS increased with age and peaked in pSS patients aged ≥60; however, adjusted HRs decreased with age. Compared to control cohorts with no drugs, adjusted HRs for shingles in pSS patients were ranked from high to low as: combined therapies (4.14; 95{\%} CI 3.14-5.45) > immunosuppressants alone (3.24; 95{\%} CI 2.36-4.45) > steroids alone (2.54; 95{\%} CI 2.16-2.97) > no pharmacological drugs (2.06; 95{\%} CI 1.76-2.41). Rates of shingles-associated hospitalization and postherpetic neuralgia were 5.62{\%} and 24.41{\%}, both of which were significantly higher than those (2.60{\%}; 13.01{\%}) in the control cohorts. Conclusions Adults with pSS were at greater risk for shingles than control cohorts. Drug exposures significantly increased the risk of shingles in pSS.",
author = "Chen, {Jen Yin} and Wang, {Li Kai} and Feng, {Ping Hsun} and Chu, {Chin Chen} and Cheng, {Tain Junn} and Weng, {Shih Feng} and Wu, {Su Zhen} and Lu, {Tsung Hsueh} and Chang, {Chia Yu} and Ilhem Messaoudi",
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Chen, JY, Wang, LK, Feng, PH, Chu, CC, Cheng, TJ, Weng, SF, Wu, SZ, Lu, TH, Chang, CY & Messaoudi, I 2015, 'Risk of shingles in adults with primary Sjogren's syndrome and treatments: A nationwide population-based cohort study', PloS one, vol. 10, no. 8, e0134930. https://doi.org/10.1371/journal.pone.0134930

Risk of shingles in adults with primary Sjogren's syndrome and treatments : A nationwide population-based cohort study. / Chen, Jen Yin; Wang, Li Kai; Feng, Ping Hsun; Chu, Chin Chen; Cheng, Tain Junn; Weng, Shih Feng; Wu, Su Zhen; Lu, Tsung Hsueh; Chang, Chia Yu; Messaoudi, Ilhem.

In: PloS one, Vol. 10, No. 8, e0134930, 25.08.2015.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Risk of shingles in adults with primary Sjogren's syndrome and treatments

T2 - A nationwide population-based cohort study

AU - Chen, Jen Yin

AU - Wang, Li Kai

AU - Feng, Ping Hsun

AU - Chu, Chin Chen

AU - Cheng, Tain Junn

AU - Weng, Shih Feng

AU - Wu, Su Zhen

AU - Lu, Tsung Hsueh

AU - Chang, Chia Yu

AU - Messaoudi, Ilhem

PY - 2015/8/25

Y1 - 2015/8/25

N2 - Background Primary Sjögren's syndrome (pSS) is associated with immunological dysfunctions - a well-known risk factor of shingles. This study aimed to examine the incidence and risk of shingles in adults with pSS and pharmacological treatments. Methods This retrospective population-based cohort study was conducted using National Health Insurance claims data. Using propensity scores, 4,287 pSS adult patients and 25,722-matched cohorts by age, gender, selected comorbidities and Charlson comorbidity index scores were identified. Kaplan-Meier analysis and Cox regression were conducted to compare the differences in developing shingles. In pSS, oral and eye dryness are treated with substitute agents. Extraglandular features are often treated with pharmacological drugs including steroids and immunosuppressants. pSS patients were grouped as follows: no pharmacological drugs, steroids alone; immunosuppressants alone; combined therapies. Results During the follow-up, 463 adults with pSS (10.80%) and 1,345 control cohorts (5.23%) developed shingles. The cumulative incidence of shingles in pSS patients (18.74/1,000 patient-years) was significantly higher than controls (8.55/1,000 patient-years). The adjusted hazard ratio (HR) of shingles was 1.69 (95% confidence interval (CI) 1.50-1.90). In age-subgroup analyses, incidences of shingles in pSS increased with age and peaked in pSS patients aged ≥60; however, adjusted HRs decreased with age. Compared to control cohorts with no drugs, adjusted HRs for shingles in pSS patients were ranked from high to low as: combined therapies (4.14; 95% CI 3.14-5.45) > immunosuppressants alone (3.24; 95% CI 2.36-4.45) > steroids alone (2.54; 95% CI 2.16-2.97) > no pharmacological drugs (2.06; 95% CI 1.76-2.41). Rates of shingles-associated hospitalization and postherpetic neuralgia were 5.62% and 24.41%, both of which were significantly higher than those (2.60%; 13.01%) in the control cohorts. Conclusions Adults with pSS were at greater risk for shingles than control cohorts. Drug exposures significantly increased the risk of shingles in pSS.

AB - Background Primary Sjögren's syndrome (pSS) is associated with immunological dysfunctions - a well-known risk factor of shingles. This study aimed to examine the incidence and risk of shingles in adults with pSS and pharmacological treatments. Methods This retrospective population-based cohort study was conducted using National Health Insurance claims data. Using propensity scores, 4,287 pSS adult patients and 25,722-matched cohorts by age, gender, selected comorbidities and Charlson comorbidity index scores were identified. Kaplan-Meier analysis and Cox regression were conducted to compare the differences in developing shingles. In pSS, oral and eye dryness are treated with substitute agents. Extraglandular features are often treated with pharmacological drugs including steroids and immunosuppressants. pSS patients were grouped as follows: no pharmacological drugs, steroids alone; immunosuppressants alone; combined therapies. Results During the follow-up, 463 adults with pSS (10.80%) and 1,345 control cohorts (5.23%) developed shingles. The cumulative incidence of shingles in pSS patients (18.74/1,000 patient-years) was significantly higher than controls (8.55/1,000 patient-years). The adjusted hazard ratio (HR) of shingles was 1.69 (95% confidence interval (CI) 1.50-1.90). In age-subgroup analyses, incidences of shingles in pSS increased with age and peaked in pSS patients aged ≥60; however, adjusted HRs decreased with age. Compared to control cohorts with no drugs, adjusted HRs for shingles in pSS patients were ranked from high to low as: combined therapies (4.14; 95% CI 3.14-5.45) > immunosuppressants alone (3.24; 95% CI 2.36-4.45) > steroids alone (2.54; 95% CI 2.16-2.97) > no pharmacological drugs (2.06; 95% CI 1.76-2.41). Rates of shingles-associated hospitalization and postherpetic neuralgia were 5.62% and 24.41%, both of which were significantly higher than those (2.60%; 13.01%) in the control cohorts. Conclusions Adults with pSS were at greater risk for shingles than control cohorts. Drug exposures significantly increased the risk of shingles in pSS.

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