Risk of Herpes Zoster in Patients with Rheumatoid Arthritis Undergoing Biologic Disease-Modifying Therapy

Abstract

Objective. Rheumatoid arthritis (RA) patients suffer from an increased risk of herpes zoster (HZ) partially due to immunosuppressant medications. This study investigated HZ in RA patients treated with biologic disease-modifying antirheumatic drugs (bDMARDs), as compared with conventional DMARDs (cDMARDs). Methods. This retrospective case series study assembled record information of 277 RA patients who received bDMARDs after failure of at least one cDMARDs at Seoul National University Hospital between August 2003 and February 2015. Following capture of baseline information and identification of HZ episodes, crude HZ incidence rates per 100 patient-years (95% confidence intervals) were calculated. Results. For 718 treatment courses, 277 (38.6%) comprised cDMARDs, 66 (9.2%) infliximab, 175 (24.4%) etanercept, 95 (13.2%) adalimumab, 9 (1.3%) golimumab, 41 (5.7%) rituximab, 31 (4.3%) abatacept, and 24 (3.3%) tocilizumab. There were 37 HZ episodes, 16 during cDMARD treatment courses, and 21 accompanying bDMARDs, two with infliximab, eight with etanercept, five with adalimumab, and three each with rituximab and abatacept. The crude HZ incidence rate per 100 patient-years was 2.4 (1.4∼3.9) for cDMARDs, 2.2 (0.3∼7.9) for infliximab, 1.8 (0.8∼3.6) for etanercept, 3.7 (1.2∼8.4) for adalimumab, 3.9 (0.8∼11.0) for rituximab, and 8.5 (1.8∼23.1) for abatacept. Conclusion. We conclude that bDMARDs do not always increase the risk of HZs in RA patients, although HZ rates vary for different bDMARDs. (J Rheum Dis 2017;24:220-226)

Prevention and management of herpes zoster in patients with rheumatoid arthritis and psoriatic arthritis: a clinical review

“…In a Japanese RA cohort, crude HZ IR was 0.67 per 100 PY and risk was significantly elevated with TNFi use versus no use (odds ratio 2.28; p=0.03) but not with use of the non-TNFi bDMARDs, tocilizumab and abatacept (16). A retrospective study of patients with RA in Korea demonstrated an IR of 2.6 per 100 PY for bDMARDs overall, but found variable risk depending on the bDMARD, with higher HZ IRs for abatacept, rituximab and adalimumab (8.5, 3.9 and 3.7 per 100 PY, respectively) versus other bDMARDs (22). TNFi data demonstrated a small risk (hazard ratio 1.63) or no increased risk for TNFi overall versus csDMARD use in patients with RA or PsA (13,14), and were inconsistent regarding relative risks of specific TNFi (13,14).…”

Association between Treatment with Biologic Agents and the Incidence of Herpes Zoster in Rheumatoid Arthritis

“…In the previous issue of the Journal of Rheumatic Diseases, Kwon et al [9] reported that among the Korean RA patients, bDMARDs did not increase the risk of developing HZ compared to cDMARDs (crude incidence rate, 2.6…”