Varicella-zoster-virus (VZV) reactivation, which can cause patients to develop herpes zoster (i.e., shingles), occurs more frequently in patients with systemic vasculitis and systemic lupus erythematosus (SLE) who have received intravenous cyclophosphamide than in otherwise healthy adults, according to a retrospective study published in The Journal of Rheumatology by researchers in France.1 The study also shows that antiviral chemoprophylaxis with valacyclovir is an effective protective option for these patients.
“Zoster is an important burden for these patients, as described in our paper and papers from other groups. Moreover, when it occurs, it makes the choice of lowering the immunosuppressant treatment—or not—more difficult if the underlying disease is not under control,” says Guillaume Moulis, MD, PhD, assistant professor in internal medicine at the University of Toulouse, and one of the study’s co-authors.
Rheumatologists often prescribe intravenous cyclophosphamide to treat severe SLE flares and systemic vasculitis, along with corticosteroids. Cyclophosphamide exposure increases the risk of severe infections.2-4