Uso de estatinas incrementa el riesgo de desarrollar Herpes Zoster.

Statin use increases risk of herpes zoster

Exposure to statins can significantly increase the odds of developing herpes zoster (HZ), according to a study published in the British Journal of Dermatology.

"The mechanisms by which statins may increase the risk of HZ are not established. As statins are commonly prescribed worldwide, any adverse effects may have substantial public health implications," wrote Anthony Matthews of the London School of Hygiene and Tropical Medicine, and his colleagues. "An increased risk of HZ would not only have an impact on the quality of life of affected patients, but could also add to the burden on health services, given the high cost of treatment for PHN [postherpetic neuralgia]."

Subjects for this matched, case-control study were drawn from the U.K. Clinical Practice Research Datalink, with adults aged 18 years and over with HZ identified and linked with their corresponding data in the Hospital Episode Statistics database in the time frame of Jan. 1, 2000, through Dec. 31, 2011.

Each subject was matched with no more than four control patients – all of whom had no prior history of HZ or PHN – selected from the same databases. Matching was based on the following criteria: subject's general practitioner (GP) practice, age (within 1 year of the HZ patient), sex, and lack of prior statin exposure. Ultimately 144,959 subjects were matched with 549,336 controls (Br J Dermatol. 2016 Dec;175[6]:1183-94).

The primary outcome was defined as incident diagnoses of HZ, which was measured via odds ratios (ORs) calculated from conditional logistic regression models and adjusted for any potential confounding factors. In addition, ORs were calculated to "explore the association between the risk of HZ and the dosage of the latest prescription (low, medium, high), stratified by time since last exposure," the investigators noted.

Results showed an adjusted OR of 1.13 for HZ after any kind of statin treatment, indicating a significant increase in risk. There was also a higher adjusted OR for those who had stopped using statins 12-36 months prior to the study than those whose last exposure was greater than 36 months prior: 1.11 and 1.06, respectively (P less than .001). Those whose current statin usage was "high" had an adjusted OR of 1.27 versus 1.16 for those whose usage was "medium," and 1.14 for those whose usage was "low" (P less than .001).

"It is clear that the preventive benefits of statin therapy are likely to outweigh the limited increase in HZ risk in many cases [but] this evidence should be taken into account by GPs when prescribing statins to those at high risk of HZ," Mr. Matthews and his associates concluded. "We would also suggest that there may be an extra motivation to maximize HZ vaccine uptake among eligible patients who are also receiving a statin."

Three coauthors disclosed individual funding sources: the Wellcome Trust/Royal Society Sir Henry Dale fellowship, the Senior Wellcome Fellowship in Clinical Science, and the National Institute for Health Research Clinician Scientist fellowship. The authors did not report any relevant financial disclosures.

"The present study by Matthews et al. observed a dose-response relationship between statin exposure and zoster risk. [It] is the first to explore the association between time since last statin use and the occurrence of zoster. As the time since last statin exposure increased, the risk of zoster decreased, suggesting that the risk for zoster is reduced after termination of statin treatment.

"Zoster is a significant contributor to morbidity, disability, and chronic pain, and constitutes a major public health concern. Zoster vaccination is recommended in most persons who are 50 years of age or older. Vaccination reduces the risk of zoster and postherpetic neuralgia. However, the price of zoster vaccine limits its use worldwide.

"The 'take home' message from the article is that in the setting of older age or immune suppression, dermatologists should consider recommending to their patients the use of a zoster vaccine, particularly in patients who receive statin therapy."

Guy Shalom, MD, is a member of the department of dermatology and venereology, Soroka Medical Center in Beer-Sheva, Israel, and reported no relevant financial conflicts. Arnon D. Cohen, MD, is a member of the Siaal Research Center for Family Medicine and Primary Care at Ben-Gurion University of the Negev, Beer-Sheva, and reported financial ties to AbbVie, Dexcel Pharma, Janssen, Novartis, Perrigo, Pfizer, and Rafa as a consultant, adviser, or speaker. These comments were excerpted from their commentary accompanying Mr. Matthews' article ( Br J Dermatol. 2017;175:1137-8 ).

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2208-8206

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