Risk of herpes zoster in patients with rheumatoid arthritis in the biologics era from 2011 to 2015 and its association with methotrexate, biologics, and corticosteroids

Abstract

Objectives To elucidate the incidence and risk factors of herpes zoster (HZ) in patients with rheumatoid arthritis (RA) in the biologics era. Methods We determined the rate of HZ occurrence among the RA patients that participated in the Institute of Rheumatology, Rheumatoid Arthritis surveys from 2011 to 2015, by assessing medical records. The standardised incidence rate per 1000 patient-years with a 95% confidence interval (CI) was calculated, and risk factors for HZ were analysed using a time-dependent Cox regression analysis. Results Among 7815 patients (female, 84.7%) contributing to 25,863 patient-years of observation, 340 HZ events in 309 patients were confirmed. The standardised incidence rate (95% CI) per 1000 patient-years was 8.5 (6.9–10.5) in total, 6.0 (3.7–9.2) in men, and 11.0 (8.7–13.7) in women. Risk factors for HZ were age per 10 years (hazard ratio 1.14, 95% CI 1.03–1.26, p < .05), Japanese version of the Health Assessment Questionnaire (J-HAQ) score of 0.5–1.5 (versus J-HAQ = 0; 1.51, 1.09–2.10, p < .05), methotrexate use (1.58, 1.06–2.36, p < .05), and biologic use (1.88, 1.44–2.47, p < .01). Conclusions In the era when biologics were frequently used and corticosteroid use and doses were decreasing, methotrexate and biologics increased the risk for HZ.

Increased Risk of Herpes Zoster in Rheumatoid Arthritis Is Not Only Due to Jak Inhibitors: Study of 392 Patients from a Single University Center

“…HZ or shingles is the result of the reactivation of VZV that rest latent in cranial and dorsal root ganglia after the primary infection normally in childhood [7][8][9][10][11][12][13][14][15][16][17][18][19] HZ is a relatively frequent infection in general population, 3-5/1000patients/year, and the estimate incidence in immunocompromised people, as RA patients, is 1.5-2 times higher 1,2 . The incidence rate for HZ in our RA cohort was 13.2 per 1000 patients-year, similar to other cohorts in classic publications and a little higher than most of them (Table 5).…”

“…HZ infection have been associated with many triggers. Between them, we find intercurrent acute illnesses, malignancy, emotional stress and use of some type of medication such as immunosuppressive agents, particularly glucocorticoids (GC) and methotrexate (MTX) [15][16][17][18].…”

Increased Risk of Herpes Zoster in Rheumatoid Arthritis Not Only Due to JAK Inhibitors—Study of 392 Patients from Single University Center

“…HZ or shingles is the result of the reactivation of VZV that rests latent in the cranial and dorsal root ganglia after a primary infection, normally in childhood [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

“…HZ infections have been associated with many triggers. Between them, we find intercurrent acute illnesses, malignancy, emotional stress, and the use of some types of medication such as immunosuppressive agents, particularly glucocorticoids (GC) and methotrexate (MTX) [ 15 , 16 , 17 , 18 ].…”

Vaccine Prophylaxis of Herpes Zoster In Rheumatic Diseases: Paradigm Revision and New Opportunities

“…В ходе анализа японской когорты из 7815 больных РА стандартизованный показатель заболеваемости HZ составил 8,5 случаев на 1000 пациенто-лет. При использовании регрессионной модели Кокса основными факторами риска развития HZ при РА были увеличение возраста на каждые 10 лет (коэффициент риска -Hazard ratio-HR 1,14, 95% ДИ 1,03-1,26, p<0,05)), интервал 0,5-1,5 балла в соответствии с японской версией опросника по оценке состояния здоровья -J-HAQ (HR 1,51, 95% ДИ 1,09-2,10, p<0,05), применение МТ (HR 1,58, 95% ДИ 1,06-2,36, p<0,05) и ГИБП (HR 1,88; 95% ДИ 1,44-2,47, p<0,01) [15].…”