Conference Coverage

Shingles infection rates higher in patients with MS


 

AT CMSC 2023

Patients with multiple sclerosis (MS) are significantly more likely to develop herpes zoster infections than immunocompetent individuals, according to research presented at the annual meeting of the Consortium of Multiple Sclerosis Centers. “Herpes zoster and its complications are associated with increased health care cost and decreased quality of life,” lead author Nikita Stempniewicz, MSc, director of U.S. Health Outcomes & Epidemiology at GSK Vaccines, Alexandria, Va., reported.

“The take-home finding is that herpes zoster incidence is high among people with MS overall,” Mr. Stempniewicz said in an interview. “We also found that herpes zoster incidence is numerically higher among MS patients with higher levels of baseline immunosuppression, so another conclusion is that herpes zoster prevention may be warranted among this population given the high level of immunosuppression and the high risk of developing herpes zoster infection.” GSK manufactures Shingrix, the only currently approved and recommended herpes zoster vaccine available in the United States

Lawrence Steinman, MD, a professor of neurology and neurological sciences, pediatrics, and genetics at Stanford (Calif.) Medicine, was not involved in the research but said in an interview that the findings “raise the issue of whether not enough individuals with MS are getting Shingrix, and also whether there is a need for rapid intervention with an antiviral, for those individuals who develop shingles.”

Real-world data

For the study, researchers analyzed U.S. administrative claims data from the Optum Research Database between October 2015 and March 2022 to compare shingles infections between adults with MS (and no other immunocompromising conditions) and a random sample of one million people without any immunocompromising conditions. The study excluded anyone who had been vaccinated against herpes zoster or diagnosed with it in the year before October 2015.

Among the 42,185 adults with MS included in the cohort, just over half (53%) were commercially insured, and 47% had Medicare Advantage. Their average age was 53, and 75% were female. Just over half the cohort (55%) had no immunosuppression because of medications while 35% had low immunosuppression from MS therapy and 10% had high immunosuppression from therapy. High suppression meant patients were taking fingolimod, siponimod, ozanimod, ponesimod, cladribine, or a monoclonal antibody except natalizumab. Those with low suppression were taking natalizumab, fumarates, IVIG, glatiramer acetate, interferon beta or a related drug, teriflunomide, azathioprine, methotrexate, or mycophenolate mofetil.

The rate of shingles infections in the MS patient population was 13.8 per 1,000 people per year, compared with 5.6 infections per 1,000 immunocompetent people per year (adjusted incident rate ratio, 1.69; 95% confidenceinterval, 1.58-1.81. When broken down by age, younger adults aged 18-49 with MS were more than three times more likely to develop shingles (incidence rate, 11.6 per 1,000 people per year) than immunocompetent younger adults (IR, 3.5). The gap was narrower for those age 50 and older, where adults with MS had a rate of 15.2 infections per 1,000 people per year versus 8.6 per 1,000 immunocompetent people per year.

Although MS patients with a higher baseline level of immunosuppression from therapy had higher herpes zoster infection rates (18 cases per 1,000 people per year) than those with low immunosuppression (14 cases per 1,000 people per year) or no immunosuppression from medication (13 cases per 1,000 people per year), rates for all three remained higher than for the immunocompetent population.

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