The risk of herpes zoster during biological therapy for psoriasis and other inflammatory conditions

Abstract

Recent advances in biological therapies have proved highly effective in treating psoriasis and other inflammatory conditions, including psoriatic arthritis, rheumatoid arthritis, inflammatory bowel disease and ankylosing spondylitis. However, adverse effects related to their immunosuppression have been observed, including an increased propensity to viral infections. This review evaluates the evidence of herpes zoster (HZ) risk from biologics based on clinical reports, cohort studies and randomized controlled studies. The risk of HZ associated with these agents remains controversial, especially when comparing their risk with non-biological therapy used to treat the same inflammatory conditions. This review specifically assesses the risk of the TNF inhibitors etanercept, adalimumab and infliximab, as well as interleukin-12/23 inhibitor ustekinumab. We found multiple cohort studies, randomized controlled trials and case reports that suggest infliximab increases risk of HZ, whereas adalimumab, etanercept and ustekinumab HZ risk remain controversial. Nevertheless, HZ vaccination should be considered prior to initiation of biological therapy, particularly infliximab.

Clinical Efficacy and Safety of Anti-IL-17 Agents for the Treatment of Patients with Psoriasis

“…The pathophysiology of psoriasis includes Th17 cell and Th1 cell lymphocyte activity, increased activity of antigen-presenting cells, production of inflammatory cytokines, epidermal hyperproliferation and angiogenesis [22]. IL-17 is a principal effector of Th17 cell.…”

Zona : risques et prévention sous immuno-modulateurs

“…En fait, le risque de zona serait différent en fonction des biomédicaments. L'infliximab semblerait être l'anti-TNF le plus à risque pour le développement du zona [19,20,22,26,27]. Cependant, là encore, les études sont contradictoires.…”

A Review of Possible Triggering or Therapeutic Effects of Antimicrobial Vaccines on Psoriasis

“…Zhang et al reported that zoster vaccination was not related to increased risk of HZ in patients with immune-mediated disease including psoriasis under biological therapy [25,26]. However, it was emphasized that infliximab increases the risk of HZ in most of the cohort studies while the risk of HZ in patients receiving etanercept, adalimumab or ustekinumab therapy is not clear [27]. Yun et al indicated that the use of biologic agents and systemic steroids in patients with autoimmune and inflammatory diseases increased the risk of HZ [28].…”

“…Consequently, HZ vaccination should be considered for patients who are going to receive biological agents especially infliximab and combination treatment with MTX therapy. Additionally, the vaccine should be administered before initiation of the immunosuppressive therapy [24,27].…”