TNFi, corticosteroids up risk of herpes zoster in patients with RA
The use of tumour necrosis factor inhibitor (TNFi) and higher dosage of corticosteroids appear to increase the incidence of herpes zoster in patients with rheumatoid arthritis (RA) in the clinical setting, according to a Japan study.
Researchers measured the crude incidence rate (IR) of herpes zoster treated with systemic antiviral medications in 1987 patients (median age 60.0 years; 81.5 percent female) from the Registry of Japanese Rheumatoid Arthritis Patients on Biologics for Longterm Safety (REAL) database.
To investigate the association between herpes zoster and medications, the authors performed a nested case–control study with 1:5 case-control pairs matched for age, sex, observation start year and comorbidity (herpes zoster group, n=43; control group, n=214).
A conditional logistic regression analysis was performed to calculate the odds ratio (OR) and 95 percent CI of the use of biological disease-modifying antirheumatic drugs (bDMARD), methotrexate (MTX) and corticosteroids for the occurrence of herpes zoster.
The median disease duration among participants was 6.0 years, and the crude IR of herpes zoster was 6.66 (95 percent CI, 4.92 to 8.83) per 1,000 person-years.
The ORs of medication use were 2.28 (1.09 to 4.76) for TNFi and 1.13 (1.03 to 1.23) for oral corticosteroid dosage (per 1 mg prednisolone increment), both of which were significantly increased. There were no increases in the ORs of non-TNFi and MTX usage.
These findings support the results of another study, which found that patients with RA taking specific immunosuppressive medication had an elevated risk of herpes zoster. Biologicals used correlated with severe herpes zoster occurrence. Researchers suggested the close monitoring and prevention of severe herpes zoster during specific immunosuppressive therapy. [BMJ Open 2017;7:e014032]