IMPACT OF HERPES ZOSTER OPHTHALMICUS ON QUALITY OF LIFE AND AGE-RELATED FUNCTIONAL DECLINE

ABSTRACT / POSTER ID # 10991

Marc LABETOULLEOphthalmology Department, Bicêtre Hospital, South Paris University, Gif/Yvette, France

E-mail: marc.labetoulle@bct.aphp.fr

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The author of this presentation has received reimbursement and fees for advisory boards or speakers bureau from Alcon, Allergan, Bausch & Lomb, Sanofi Pasteur MSD, Santen, Thea

CONFLICTS OF INTEREST

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Herpes Zoster (HZ) is a painful and debilitating disease, which incidence and severity increase with age.

Whereas the burden of Post Herpetic Neuralgia (PHN), its main complication, has been evaluated in several studies, the specific impact of Herpes Zoster Ophthalmicus (HZO) on health-related quality of life (HR-QoL) and functional decline has been poorly studied.

A study is needed to assess the impact of HZO

in elderly patients

PURPOSE

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To present the rationale of this study To describe its planned design

OBJECTIVE

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A multidisciplinary group performed a narrative analysis of the literature on the relationship between HZ (HZO incl.) and functional decline.

Multidisciplinary group (by alphabetic order): Nadine ATTAL, Neurologist, Pain Specialist, Paris Claire DEBACK, Virologist, Paris Gaétan GAVAZZI, Geriatrician, Grenoble Marc LABETOULLE, Ophthalmologist, Paris François LIARD, General practitioner, Saint-Epain Philip GORWOOD, Psychiatrist, Paris Gisèle PICKERING, Pharmacologist, Pain Specialist,

Clermont-Ferrand

METHODS

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Varicella-Zoster-Virus (VZV) is a human α-herpesvirus. VZV establishes life-long latency after initial infection. HZ results from reactivation of VZV. In Europe, almost all adults have had varicella (mainly

during their childhood) and can potentially suffer from HZ.

Waning of VZV-specific cell-mediated immunity associated with the normal aging process (immunosenescence) is the key-risk factor for reactivation of VZV and HZ development [1].

It has been estimated that 1 in 4 people will develop HZ during their lifetime, and up to 1 in 2 people among 85+.

Several studies have clearly shown that the incidence and severity of HZ and PHN (i.e., pain continuing 90 days or longer after the rash onset) increase with age

HERPES ZOSTER (HZ)

[1] Arvin A. N Engl J Med 2005;352:2266-7

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HZO occurs with reactivation of VZV in the ophthalmic division of the trigeminal nerve.

HZO represents ≈ 10% of all HZ cases [1]. At least 50% of patients with HZO will have direct

ocular impairment (e.g., conjunctivitis, keratitis, uveitis, optic neuritis, retinal necrosis).

HZ-associated eye complications require an average of 10 months of medical care with 7% of cases resulting in vision loss [2].

HERPES ZOSTER OPHTHALMICUS (HZO)

[1] Kawai K. BMJ Open 2014; [2] Yawn BP. Mayo Clin Proc 2013;88:562–70

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Functional decline is defined by reduced ability to perform everyday activities.

Functional decline is enhanced with age, comorbidities, and infections (such as HZ) [1].

FUNCTIONAL DECLINE

[1] McElhaney JE Expert Rev Vaccines 2010;9:27–30

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Several studies have clearly shown that HZ and PHN, dramatically impairs HR-QoL and functional status [1, 2].

HZO has a poor prognosis, with short and long-term sequelae, including chronic ocular inflammation, visual loss, and disabling pain.

In addition to the risk for ocular complications, HZO may be associated with increased risk of severe pain, PHN, and possibly fatal strokes within 1 year [3].

BURDEN OF THE DISEASE

[1] Oxman MN. N Engl J Med 2005;352[22]:2271-84; [2] Bouhassira D. Pain 2012;153:342-49; Lin HC. Neurology 2010;74:792-7.

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Objectives Primary objectives

To assess the impact of HZ, regardless of its localization, on HR-QoL in patients aged 50 years and over after the diagnosis of acute using generic (EQ-5D) and specific (ZBPI) instruments.

To assess the impact of HZO on HR-QoL with specific ophthalmic impact scales (NEI VFQ 25, OSD-QoL)

Secondary objectives To describe evolution of scores regarding timing,

severity of the disease, age of patient, pain intensity, chronic ophthalmologic complications, treatments

DESIGN OF QUALIPZO STUDY (QUALITY OF LIFE IN PATIENTS WITH HERPES ZOSTER)

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Patients (≈ 800 patients with HZ, ≈ 80 patients with HZO) ≥ 50 years of age Diagnosis of acute HZ on D0 Provided written informed consent

Investigators ≈ 1,500 general practitioners (GPs), selected in 2 groups:

GPs who have been active investigators in the ARIZONA* study [1] ≈ 2,000 GPs aware of the disease and representative of the French GPs population

GPs of the “Sentinelles” network (INSERM) = GPs aware of the disease

Study flow chart

DESIGN OF QUALIPZO STUDY (QUALITY OF LIFE IN PATIENTS WITH HERPES ZOSTER)

[1] Bouhassira D. Pain 2012;153:342-49.

D-15

EQ-5D ZBPI

NEI VFQ 25OSD-QoL

EQ-5D ZBPI

NEI VFQ 25OSD-QoL

EQ-5D ZBPI

NEI VFQ 25OSD-QoL

D0 M3 M12

EQ-5D ZBPI

NEI VFQ 25OSD-QoL

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This study will provide specific data on HZ impact on HR-QoL in patients aged 50 years and over with a specific focus on HZO.

Keywords:

Ageing; Functional decline; Herpes Zoster Ophthalmicus; Keratitis; Pain

CONCLUSION

World Cornea Congress VII – San Diego 2015 - Abstract & Poster # 10991