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Increased Risk of Herpes Zoster in Patients with Inflammatory Bowel Disease: A Nationwide Population-based Study : 염증성 장질환 환자에서 대상포진의 위험도 분석: 전국민 기반 코호트 연구

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Authors
소호심
Advisor
김주성
Major
의과대학 의학과
Issue Date
2018-02
Publisher
서울대학교 대학원
Keywords
Inflammatory bowel diseaseCrohn’s diseaseulcerative colitisherpes zosternationwide study
Description
학위논문 (석사)-- 서울대학교 대학원 : 의과대학 의학과, 2018. 2. 김주성.
Abstract
Introduction
The incidence and risk factors of herpes zoster (HZ) among patients with inflammatory bowel disease (IBD) still remains unclear in Asian population. We conducted a nationwide population-based study in order to investigate the risk of HZ in patients with IBD.

Methods
We conducted a retrospective study using claim data from the National Healthcare Insurance service in Korea. The patients with Crohns disease (CD) and ulcerative colitis (UC) were identified through both ICD-10 codes and the rare/intractable disease registration program codes which provide co-payment reduction of up to 90% in Korea. We compared 30,100 IBD patients (10,517 CD and 19,583 UC patients) with 150,500 non-IBD controls matched by age and sex with a ratio of 1:5. Patients who were newly diagnosed with HZ were identified through ICD-10 code. The Kaplan–Meier method was used to estimate the cumulative probability of HZ in patients with IBD.

Results
During the mean follow-up of 5 years, HZ was newly detected in 676 (6.43%) CD patients, 1395 (7.12%) UC patients, and 6,672 (4.43%) controls, respectively. The incidence rate of HZ (per 1,000 person-years) was 13.60, 15.00 and 9.19 in CD, UC patients, and non-IBD individuals, respectively. Compared to controls, the overall risk of HZ was significantly higher in CD (adjusted hazard ratio [HR], 2.13
95% confidence interval [CI], 1.95-2.33
p<0.0001] and UC patients (adjusted HR, 1.40
95% CI, 1.32-1.48
p<0.0001], respectively. The impact of CD on development of HZ was more prominent in younger age (p=0.0012 by interaction analysis), male gender (p=0.176), and patients without any metabolic disease including hypertension, diabetes mellitus, and dyslipidemia (p=0.015), respectively. Moreover, the impact of UC on development of HZ also increased in younger age (p=0.014), male gender (p=0.002), and patients without metabolic disease (p=0.0004) or cancer (p=0.181), respectively. In patients with both CD and UC, use of steroid, immunomodulators including azathioprine, 6-mercaptopurine, and methotrexate, or anti-tumor necrosis factor including infliximab and adalimumab significantly increased the risk of HZ compared to controls, respectively.

Conclusion
The risk of HZ increased in patients with IBD. The development of HZ should be monitored carefully in patients with IBD, especially in young or male patients, or in those without metabolic disease or cancer.
Language
English
URI
https://hdl.handle.net/10371/142336
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Medicine (의학과)Theses (Master's Degree_의학과)
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