Biologic, targeted synthetic DMARDs linked to increased herpes zoster risk
medwireNews: Biologic (b) and targeted synthetic (ts) DMARD use is associated with an elevated risk for herpes zoster in patients with rheumatoid arthritis (RA) compared with conventional synthetic (cs)DMARDs, according to research presented at the EULAR 2020 E-congress.
Anja Strangfeld (German Rheumatism Research Centre, Berlin) explained that, when stratified by mode of action, Janus kinase (JAK) inhibitors conferred the greatest risk for herpes zoster in this cohort of 12,470 RA patients from the German RABBIT registry who initiated treatment with a bDMARD or tsDMARD or changed their csDMARD treatment between 2007 and 2019.
During up to 10 years of follow-up, a total of 452 herpes zoster events (52 serious) were recorded in 433 patients; this translated to an incidence rate for herpes zoster of 8.6 events per 1000 person–years.
Stratification by mode of action showed that the crude incidence rate of herpes zoster was significantly higher only among individuals who took JAK inhibitors versus those who received csDMARDs, at 24.9 versus 5.8 events per 1000 person–years.
Indeed, in a multivariate analysis adjusted for inverse probability weights, the use of JAK inhibitors was associated with a significant fivefold risk for herpes zoster.
There was also a significant 1.6–1.7 times increased risk for herpes zoster with the use of monoclonal tumor necrosis factor (TNF) inhibitors, a T-cell co-stimulation modulator, B-cell targeted therapies, and interleukin (IL)-6 inhibitors.
No such association was found, however, among patients who were taking soluble TNF inhibitors, reported Strangfeld.
And she concluded: “These findings clearly support that systematic herpes zoster vaccination of RA patients should become standard of practice.”
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