Corticosteroid Use and Risk of Herpes Zoster in a Population-Based Cohort

Jiahui Qian; Emily Banks; Kristine Macartney; Anita Elizabeth Heywood; Marissa Nichole Lassere; Bette Liu

doi:10.1016/j.mayocp.2021.05.029

Corticosteroid Use and Risk of Herpes Zoster in a Population-Based Cohort

Mayo Clin Proc. 2021 Nov;96(11):2843-2853. doi: 10.1016/j.mayocp.2021.05.029.

Authors

Jiahui Qian¹, Emily Banks², Kristine Macartney³, Anita Elizabeth Heywood⁴, Marissa Nichole Lassere⁵, Bette Liu⁴

Affiliations

¹ School of Population Health, University of New South Wales, Sydney, NSW, Australia. Electronic address: [email protected].
² National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia; The Sax Institute, Sydney, NSW, Australia.
³ National Centre for Immunisation Research and Surveillance, Westmead, NSW, Australia; Discipline of Child and Adolescent Health, University of Sydney, Sydney, NSW, Australia.
⁴ School of Population Health, University of New South Wales, Sydney, NSW, Australia.
⁵ School of Population Health, University of New South Wales, Sydney, NSW, Australia; St George Hospital, Kogarah, NSW, Australia.

PMID: 34736610
DOI: 10.1016/j.mayocp.2021.05.029

Abstract

Objective: To examine the relationship between corticosteroid use and herpes zoster risk.

Methods: With data from a large cohort of adults (the 45 and Up Study) recruited between 2006 and 2009 and linked to health data sets, the effect of corticosteroid use on zoster risk was analyzed by Cox proportional hazards models, adjusting for age, sex, and other characteristics.

Results: During 602,152 person-years (median, 7.36 years) of follow-up, there were 20,048 new systemic corticosteroid users and 6294 incident herpes zoster events among 94,677 participants (zoster incidence, 11.0 per 1000 person-years). Compared with nonusers, the risk of zoster was 59% higher in those using systemic corticosteroids (adjusted hazard ratio [aHR], 1.59; 95% CI, 1.48 to 1.71) and greater with higher cumulative doses: aHR of 1.32 (95% CI, 1.17 to 1.48), 1.74 (95% CI, 1.55 to 1.95), and 1.80 (95% CI, 1.61 to 2.02) for use of less than 500 mg, 500 mg to less than 1000 mg, and 1000 mg or more prednisolone equivalents, respectively (P value for trend, <.001). Compared with nonusers, zoster risk increased significantly (aHR, 6.00; 95% CI, 4.85 to 7.42) in the month after a single prescription of systemic corticosteroids and returned to levels similar to those in nonusers by the third month after dispensing (aHR, 0.91; 95% CI, 0.49 to 1.69).

Conclusion: Practitioners should be alert to the increased risk of zoster among patients taking systemic corticosteroids. Given the significant morbidity from zoster, particularly in older adults, these findings support judicious prescribing of corticosteroids, including using as low a dose and as short a course as possible.

Keywords: Cohort; Corticosteroids; Herpes zoster.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones* / administration & dosage
Adrenal Cortex Hormones* / adverse effects
Aged
Cohort Studies
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Herpes Zoster* / diagnosis
Herpes Zoster* / epidemiology
Herpes Zoster* / prevention & control
Humans
Incidence
Male
Middle Aged
Practice Patterns, Physicians'
Prednisolone* / administration & dosage
Prednisolone* / adverse effects
Proportional Hazards Models
Risk Adjustment / methods*
Risk Factors
United States / epidemiology

Substances

Adrenal Cortex Hormones
Prednisolone