March 13, 2013
TNF Antagonists Don’t Raise Shingles Risk in Inflammatory Disease Patients

Portland, OR—Use of antitumor necrosis factor therapies does not appear to raise the risk of herpes zoster in patients with rheumatoid arthritis (RA) and other inflammatory diseases, according to an analysis including nearly 60,000 patients.

The research, reported recently in the Journal of the American Medical Association, sought to determine what role the drugs played in the disproportionately higher incidence of shingles in RA patients.

“For patients with rheumatoid arthritis, the risk of herpes zoster is elevated an additional 2- to 3-fold. The contribution of widely used biologic immunosuppressive therapy to this increased risk is not well understood,” according to the study led by Kevin L. Winthrop, MD, MPH, of Oregon Health and Science University. “These therapies, including tumor necrosis factor (TNF) antagonists, are commonly used to treat RA and a variety of other immune-mediated inflammatory diseases and have clearly been associated with an increased risk of tuberculosis and other opportunistic infections.”

Noting in the article’s background that “it is unclear whether anti-tumor necrosis factor (anti-TNF) therapy elevates herpes zoster risk,” the researchers compared rates with those initiating nonbiologic treatment regimens.

For the study, which employed data from 1998 to 2007, researchers identified new users of anti-TNF therapy among groups of patients with RA, inflammatory bowel disease, psoriasis, psoriatic arthritis, or ankylosing spondylitis from 1998 through 2007 within a large, multi-institutional collaboration across the United States. Herpes zoster incidence in 33,324 new anti-TNF users and 25,743 patients initiating nonbiologic disease-modifying antirheumatic drugs (DMARDs) were compared within each inflammatory disease cohort.

According to reported results, 310 herpes zoster cases were identified among anti-TNF users, with 160 cases among nonbiologic DMARD users, across all disease indications. Specifically for RA patients, adjusted incidence rates were similar between anti-TNF and nonbiologic DMARD initiators and comparable between all three anti-TNF therapies studied, researchers found.

Elevated risk was associated with baseline use of corticosteroids of 10 mg/d or greater among all disease indications, compared with no baseline use.

“In summary, among patients with RA and other select inflammatory diseases, those who initiated anti-TNF therapies were not at higher risk of herpes zoster compared with patients who initiated non-biologic treatment regimens,” the authors write.

In addition to higher-dose corticosteroid use, risk factors for herpes zoster within the RA group were found to be increasing age, female sex and overall health status.

U.S. Pharmacist Social Connect