{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T06:53:12Z","timestamp":1767855192576,"version":"3.49.0"},"reference-count":49,"publisher":"The Journal of Rheumatology","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To assess the incidence and the risk factors for zoster in patients exposed to intravenous cyclophosphamide (CYC) for systemic vasculitis or systemic lupus erythematosus (SLE), as well as the protective effect of prophylaxis by valacyclovir (VCV).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>This retrospective study included all adults treated by intravenous CYC for SLE or systemic vasculitis between 2011 and 2015 at Toulouse University Hospital, France. Zoster occurrence was recorded using medical chart review, laboratory data, and patient interviews. Univariate Cox models were computed to assess the risk factors for zoster and the protective effect of prophylaxis by VCV.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>The cohort consisted of 110 patients (81 systemic vasculitis and 29 SLE). During a mean followup of 3.4 years after CYC initiation, 10 cases of zoster occurred, leading to an overall incidence of 27.9\/1000 patient-years (95% CI 15.2\u201350.6); it was 59.4\/1000 patients (95% CI 27.5\u2013123.6) during the year after CYC initiation. Four patients experienced persistent postherpetic neuralgia. Probable risk factors were lymphopenia &lt; 500\/<jats:italic>\u00b5<\/jats:italic>l at CYC initiation (HR 5.11, 95% CI 0.94\u201327.93) and female sex (HR 4.36, 95% CI 0.51\u201337.31). The incidence was higher in patients with SLE (HR as compared with systemic vasculitis patients = 2.68, 95% CI 0.54\u201313.26). None of the 19 patients exposed to VCV during the followup developed zoster.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>The incidence of zoster is high in systemic vasculitis and in patients with SLE exposed to intravenous CYC. CYC may favor postherpetic neuralgia. Prophylaxis by VCV should be considered, particularly in cases of lymphopenia &lt; 500\/<jats:italic>\u00b5<\/jats:italic>l at CYC initiation and during the year after.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.180310","type":"journal-article","created":{"date-parts":[[2018,7,15]],"date-time":"2018-07-15T07:25:11Z","timestamp":1531639511000},"page":"1541-1548","source":"Crossref","is-referenced-by-count":13,"title":["Zoster after Cyclophosphamide for Systemic Lupus Erythematosus or Vasculitis: Incidence, Risk Factors, and Effect of Antiviral Prophylaxis"],"prefix":"10.3899","volume":"45","author":[{"given":"Camille","family":"Garnier","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Ribes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominique","family":"Chauveau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antoine","family":"Huart","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gr\u00e9gory","family":"Pugnet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Adoue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gr\u00e9goire","family":"Prevot","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurent","family":"Alric","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre","family":"Delobel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H\u00e9l\u00e8ne","family":"Derumeaux","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Mengelle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laurent","family":"Sailler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9953-4640","authenticated-orcid":false,"given":"Guillaume","family":"Moulis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2262","published-online":{"date-parts":[[2018,7,15]]},"reference":[{"key":"2018112909391304000_45.11.1541.1","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/jdv.13995","article-title":"European consensus-based (S2k) Guideline on the Management of Herpes Zoster - guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), part 1: diagnosis","volume":"31","author":"Werner","year":"2017","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2018112909391304000_45.11.1541.2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-013-0550-8"},{"key":"2018112909391304000_45.11.1541.3","doi-asserted-by":"publisher","DOI":"10.1002\/art.23883"},{"key":"2018112909391304000_45.11.1541.4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.rdc.2016.09.010","article-title":"Incidence and prevention of herpes zoster reactivation in patients with autoimmune diseases","volume":"43","author":"Chakravarty","year":"2017","journal-title":"Rheum Dis Clin North Am"},{"key":"2018112909391304000_45.11.1541.5","doi-asserted-by":"crossref","first-page":"2328","DOI":"10.1002\/art.39670","article-title":"Risk of herpes zoster in autoimmune and inflammatory diseases: implications for vaccination","volume":"68","author":"Yun","year":"2016","journal-title":"Arthritis Rheumatol"},{"key":"2018112909391304000_45.11.1541.6","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.jbspin.2016.04.001","article-title":"Herpes zoster: risk and prevention during immunomodulating therapy","volume":"84","author":"Tran","year":"2017","journal-title":"Joint Bone Spine"},{"key":"2018112909391304000_45.11.1541.7","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofw205"},{"key":"2018112909391304000_45.11.1541.8","first-page":"84","article-title":"Herpes zoster infections in systemic lupus erythematosus: risk factors and outcome","volume":"21","author":"Kahl","year":"1994","journal-title":"J Rheumatol"},{"key":"2018112909391304000_45.11.1541.9","first-page":"1254","article-title":"Herpes zoster in systemic lupus erythematosus","volume":"22","author":"Manzi","year":"1995","journal-title":"J Rheumatol"},{"key":"2018112909391304000_45.11.1541.10","doi-asserted-by":"publisher","DOI":"10.1097\/RHU.0b013e3181d52ed7"},{"key":"2018112909391304000_45.11.1541.11","doi-asserted-by":"publisher","DOI":"10.1177\/0961203312470186"},{"key":"2018112909391304000_45.11.1541.12","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1590\/S1807-59322011000700009","article-title":"Risk of herpes zoster in patients with systemic lupus erythematosus: a three-year follow-up study using a nationwide population-based cohort","volume":"66","author":"Chen","year":"2011","journal-title":"Clinics"},{"key":"2018112909391304000_45.11.1541.13","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jaad.2015.12.059","article-title":"Immunosuppressive medication use and risk of herpes zoster (HZ) in patients with systemic lupus erythematosus (SLE): A nationwide case-control study","volume":"75","author":"Hu","year":"2016","journal-title":"J Am Acad Dermatol"},{"key":"2018112909391304000_45.11.1541.14","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.160041"},{"key":"2018112909391304000_45.11.1541.15","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-116-6-488"},{"key":"2018112909391304000_45.11.1541.16","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.088302"},{"key":"2018112909391304000_45.11.1541.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.06.011"},{"key":"2018112909391304000_45.11.1541.18","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2007.070367"},{"key":"2018112909391304000_45.11.1541.19","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/rheumatology\/kex286","article-title":"The British Society for Rheumatology guideline for the management of systemic lupus erythematosus in adults","volume":"57","author":"Gordon","year":"2018","journal-title":"Rheumatology"},{"key":"2018112909391304000_45.11.1541.20","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209133"},{"key":"2018112909391304000_45.11.1541.21","doi-asserted-by":"crossref","first-page":"1626","DOI":"10.1002\/anr.1780321224","article-title":"Infectious complications of cyclophosphamide treatment for vasculitis","volume":"32","author":"Hoffman","year":"1989","journal-title":"Arthritis Rheum"},{"key":"2018112909391304000_45.11.1541.22","doi-asserted-by":"publisher","DOI":"10.1002\/art.10461"},{"key":"2018112909391304000_45.11.1541.23","doi-asserted-by":"crossref","first-page":"882","DOI":"10.6004\/jnccn.2016.0093","article-title":"Prevention and treatment of cancer-related infections, version 2.2016, NCCN Clinical Practice Guidelines in Oncology","volume":"14","author":"Baden","year":"2016","journal-title":"J Natl Compr Cancer Netw"},{"key":"2018112909391304000_45.11.1541.24","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.antiviral.2017.01.011","article-title":"Antiviral prophylaxis for preventing herpes zoster in hematopoietic stem cell transplant recipients: a systematic review and meta-analysis","volume":"140","author":"Seo","year":"2017","journal-title":"Antiviral Res"},{"key":"2018112909391304000_45.11.1541.25","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780400928"},{"key":"2018112909391304000_45.11.1541.26","doi-asserted-by":"publisher","DOI":"10.1002\/art.37715"},{"key":"2018112909391304000_45.11.1541.27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1403062"},{"key":"2018112909391304000_45.11.1541.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2010.09.074"},{"key":"2018112909391304000_45.11.1541.29","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006"},{"key":"2018112909391304000_45.11.1541.30","doi-asserted-by":"publisher","DOI":"10.1177\/0962280206071639"},{"key":"2018112909391304000_45.11.1541.31","unstructured":"Sentinelles network . Herpes zoster in France. 2015. [Internet. Web page in French. Accessed June 22, 2018]. Available from: websenti.u707.jussieu.fr\/sentiweb\/?page=maladies&mal=14"},{"key":"2018112909391304000_45.11.1541.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbspin.2013.07.009"},{"key":"2018112909391304000_45.11.1541.33","doi-asserted-by":"publisher","DOI":"10.1136\/ard.49.8.630"},{"key":"2018112909391304000_45.11.1541.34","first-page":"274","article-title":"Close association of herpes zoster reactivation and systemic lupus erythematosus (SLE) diagnosis: case-control study of patients with SLE or noninflammatory nusculoskeletal disorders","volume":"31","author":"Pope","year":"2004","journal-title":"J Rheumatol"},{"key":"2018112909391304000_45.11.1541.35","first-page":"174891","article-title":"Herpes zoster infections in SLE in a university hospital in Saudi Arabia: risk factors and outcomes","volume":"2011","author":"Sayeeda","year":"2010","journal-title":"Autoimmune Dis"},{"key":"2018112909391304000_45.11.1541.36","doi-asserted-by":"crossref","first-page":"314","DOI":"10.2340\/00015555-1454","article-title":"Lymphopaenia, anti-Ro\/anti-RNP autoantibodies, renal involvement and cyclophosphamide use correlate with increased risk of herpes zoster in patients with systemic lupus erythematosus","volume":"93","author":"Hu","year":"2013","journal-title":"Acta Derm Venereol"},{"key":"2018112909391304000_45.11.1541.37","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1016\/S0002-9343(80)80014-3","article-title":"Herpes zoster in patients with treated Wegener\u2019s granulomatosis. A possible role for cyclophosphamide","volume":"69","author":"Cupps","year":"1980","journal-title":"Am J Med"},{"key":"2018112909391304000_45.11.1541.38","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780390906"},{"key":"2018112909391304000_45.11.1541.39","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.reuma.2014.09.003","article-title":"Severe infections in patients with autoimmune diseases treated with cyclophosphamide","volume":"11","author":"Cavallasca","year":"2015","journal-title":"Reumatol Clin"},{"key":"2018112909391304000_45.11.1541.40","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-011-2151-0"},{"key":"2018112909391304000_45.11.1541.41","doi-asserted-by":"crossref","first-page":"e843","DOI":"10.1097\/MD.0000000000000843","article-title":"The CD4 lymphocyte count is a better predictor of overall infection than the total lymphocyte count in ANCA-associated vasculitis under a corticosteroid and cyclophosphamide regimen: a retrospective cohort","volume":"94","author":"Shi","year":"2015","journal-title":"Medicine"},{"key":"2018112909391304000_45.11.1541.42","doi-asserted-by":"crossref","first-page":"e0144918","DOI":"10.1371\/journal.pone.0144918","article-title":"National lupus hospitalization trends reveal rising rates of herpes zoster and declines in pneumocystis pneumonia","volume":"11","author":"Murray","year":"2016","journal-title":"PLoS One"},{"key":"2018112909391304000_45.11.1541.43","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-13-170"},{"key":"2018112909391304000_45.11.1541.44","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(03)00857-0"},{"key":"2018112909391304000_45.11.1541.45","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-015-1262-8"},{"key":"2018112909391304000_45.11.1541.46","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.07300712"},{"key":"2018112909391304000_45.11.1541.47","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780401213"},{"key":"2018112909391304000_45.11.1541.48","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.7304"},{"key":"2018112909391304000_45.11.1541.49","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1093\/cid\/cix484","article-title":"Safety and immunogenicity of inactivated varicella-zoster virus vaccine in adults with autoimmune disease: a phase 2, randomized, double-blind, placebo-controlled clinical trial","volume":"65","author":"Eberhardson","year":"2017","journal-title":"Clin Infect Dis"}],"container-title":["The Journal of Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3899\/jrheum.180310","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2018,11,29]],"date-time":"2018-11-29T14:30:09Z","timestamp":1543501809000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.jrheum.org\/lookup\/doi\/10.3899\/jrheum.180310"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,15]]},"references-count":49,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2018,11,1]]},"published-print":{"date-parts":[[2018,11]]}},"alternative-id":["10.3899\/jrheum.180310"],"URL":"https:\/\/doi.org\/10.3899\/jrheum.180310","relation":{},"ISSN":["0315-162X","1499-2752"],"issn-type":[{"value":"0315-162X","type":"print"},{"value":"1499-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,7,15]]}}}