J Rheum Dis.  2017 Aug;24(4):220-226. 10.4078/jrd.2017.24.4.220.

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

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. leb7616@snu.ac.kr
  • 2Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Korea.

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.

Keyword

Herpes zoster; Rheumatoid arthritis; Biological therapies; Antirheumatic agents

MeSH Terms

Abatacept
Adalimumab
Antirheumatic Agents
Arthritis, Rheumatoid*
Biological Therapy
Etanercept
Herpes Zoster*
Humans
Incidence
Infliximab
Retrospective Studies
Rituximab
Seoul
Abatacept
Adalimumab
Antirheumatic Agents
Etanercept
Infliximab
Rituximab

Cited by  1 articles

Association between Treatment with Biologic Agents and the Incidence of Herpes Zoster in Rheumatoid Arthritis
Doo-Ho Lim, Yong-Gil Kim
J Rheum Dis. 2017;24(5):251-252.    doi: 10.4078/jrd.2017.24.5.251.


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