27478 Herpes zoster and immunosuppression among patients with psoriasis or psoriatic arthritis on drug therapy

Abstract

Immune-mediated dermotologic conditions such as psoriasis (PsO) and psoriatic arthritis (PsA) are associated with risk of infections such as herpes zoster (HZ ) (Baumrim et al, 2019). To date, the association between medication classes and risk of HZ infection in this cohort remains poorly characterized. Through a retrospective analysis, we aimed to characterize patients with PsO or PsA who had confirmed HZ. We examined the concurrent PsO and PsA treatments including disease-modifying antirheumatic drugs (DMARDs) and/or biologics. From a total of 1181 PsO or PsA patients seen by dermatology between January 2011 and July 2020, 34 (2.9%) had confirmed HZ. Among those with HZ, 22 (64.7%) were female, 25 (73.5%) were white, and the median age was 57 years (interquartile range, IQR: 46-65). Seventeen patients (50%) had commercial insurance, 15 (44.1%) had Medicare, and 1 (2.9%) had Medicaid. Twenty-five (73.5%) patients had a history of DMARDs and/or biologics use. The most common DMARD was methotrexate (85%) and most common biologic class were the TNF-alpha inhibitors (63.2%). PsO and PsA patients commonly switch medications and we sought to asses association of drug class and temporality of HZ diagnosis. Interestingly, 16 (47.1%) patients were not on a DMARD nor biologic at the time of HZ diagnosis. Moreover, no specific medication was found to be more commonly associated with HZ diagnosis. Our study further highlights the importance of monitoring patients with psoriasis and psoriatic arthritis on immunomodulatory therapies for herpes zoster infection.