Tofacitinib use may increase risk of herpes zoster
Treatment with tofacitinib appears to increase the risk of herpes zoster (HZ) compared with placebo, according to a recent study. The risk factors for heightened risk are Asian descent, increasing age, higher dose and prior biologic exposure.
Researchers calculated HZ incidence rates (IR; events per 100 patient-years) by using phases II and III and long-term extension data from the tofacitinib development programme in psoriasis. Cox-proportional hazard models were used to evaluate potential HZ risk factors.
Overall, HZ occurred in 130 (3.6 percent) patients on tofacitinib (IR, 2.55), no patients on placebo and two using etanercept (IR, 2.68). A total of nine patients (7 percent) were admitted to the hospital, and eight (6 percent) had multidermatomal HZ. There were no encephalitis, visceral involvement or deaths recorded. A total of 121 (93 percent) patients on tofacitinib continued or resumed use after HZ.
Asian race (hazard ratio [HR], 2.92), using tofacitinib 10 mg twice daily (vs 5 mg twice daily; HR, 1.72), prior use of biologics (HR, 1.72) and older age (HR, 1.30) were risk factors for HZ risk.
These findings support the results of two earlier studies, which concluded that HZ rates increased in patients treated with tofacitinib compared with those receiving placebo, particularly among patients within Asia and those using biologics. [Arthritis Rheumatol 2014;66:2675-84; Ann Rheum Dis 2016;75:1843-7]
In the current study, generalizability to other psoriasis populations might be limited. Furthermore, the effect of HZ vaccination was not examined.
“Tofacitinib is an oral Janus kinase inhibitor. Immunomodulatory therapies can increase the risk for HZ in patients with psoriasis,” according to researchers.