Use of certain therapies for inflammatory diseases does not appear to increase risk of shingles

March 5, 2013, JAMA and Archives Journals

Although patients with rheumatoid arthritis (RA) have a disproportionately higher incidence of herpes zoster (shingles), an analysis that included nearly 60,000 patients with RA and other inflammatory diseases found that those who initiated anti-tumor necrosis factor therapies were not at higher risk of herpes zoster compared with patients who initiated nonbiologic treatment regimens, according to a study appearing in the March 6 issue of JAMA.

"For patients with , the risk of herpes zoster is elevated an additional 2- to 3-fold. The contribution of widely used biologic to this increased risk is not well understood. These therapies, including tumor necrosis factor (TNF) antagonists, are commonly used to treat RA and a variety of other immune-mediated inflammatory diseases and have clearly been associated with an increased risk of tuberculosis and other opportunistic infections," according to background information in the article. "It is unclear whether anti- (anti-TNF) therapy elevates herpes zoster risk."

Kevin L. Winthrop, M.D., M.P.H., of Oregon Health and Science University, Portland, Ore., and colleagues conducted a study to determine whether initiation of anti-TNF therapy compared with non-biologic comparators is associated with increased herpes zoster risk. The researchers identified new users of anti-TNF therapy among groups of patients with RA, , and psoriasis, , or ankylosing spondylitis from 1998 through 2007 within a large U.S. multi-institutional collaboration. The authors compared herpes zoster incidence between new anti-TNF users (n = 33,324) and patients initiating nonbiologic disease-modifying (DMARDs) (n = 25,742) within each inflammatory disease cohort (last participant follow-up December 31, 2007).

Across all disease indications, there were 310 herpes zoster cases among anti-TNF and 160 among nonbiologic DMARD users. For patients with RA, the researchers found that adjusted incidence rates were similar between anti-TNF and nonbiologic DMARD initiators and comparable between all 3 anti-TNF therapies studied. Baseline use of corticosteroids of 10 mg/d or greater among all disease indications was associated with elevated risk compared with no baseline use.

After adjustment for various factors, no significant difference in herpes zoster rates was observed within any disease indication between patients initiating anti-TNF therapy and those initiating new DMARD regimens.

Within the RA group, herpes zoster risk was associated with increasing age, female sex, overall health status, and higher-dose corticosteroid use.

"In summary, among patients with RA and other select , those who initiated anti-TNF therapies were not at higher risk of herpes zoster compared with patients who initiated nonbiologic treatment regimens," the authors write.

Explore further: No increased risk of cancer for people with shingles

More information: JAMA. 2013;309(9):887-895

Related Stories

No increased risk of cancer for people with shingles

September 17, 2012
Herpes zoster, or shingles, does not increase the risk of cancer in the general population, according to a study in CMAJ (Canadian Medical Association Journal).

Shingles vaccine among patients with psoriasis, rheumatoid arthritis not linked with increased risk of shingles

July 3, 2012
Although some have suggested that patients receiving medication for immune-mediated diseases such as rheumatoid arthritis or psoriasis may be at increased risk of herpes zoster (HZ; shingles) shortly after receipt of the ...

Common rheumatoid arthritis and psoriasis medications are associated with reduced diabetes risk

June 21, 2011
Individuals with systemic inflammatory conditions, such as rheumatoid arthritis (RA) and psoriasis, experience a 1.5 to 2-fold increased rate of cardiovascular disease. Previous research suggests that inflammation and insulin ...

Treatment with anti-TNFs can increase the risk of shingles by up to 75 percent

June 7, 2012
Patients with inflammatory rheumatic diseases (IRD) treated with anti-tumour necrosis factor medications (anti-TNFs) have a 75% greater risk of developing herpes zoster, or shingles, than patients treated with traditional ...

Recommended for you

Chronic inflammation causes loss of muscle mass during aging

January 12, 2018
People start losing muscle mass at the age of 40—about some 10 percent of the total muscle mass for each 10-year period, which may lead to fall-related injuries, slowing metabolism and reduced quality of life. Today, very ...

Breathing exercises help asthma patients with quality of life

December 13, 2017
A study led by the University of Southampton has found that people who continue to get problems from their asthma, despite receiving standard treatment, experience an improved quality of life when they are taught breathing ...

Study highlights the need for research into prevention of inflammatory bowel disease

December 7, 2017
Countries in Africa, Asia, the Middle East and South America have seen a rise in incidence of inflammatory bowel disease as they have become increasingly industrialised and westernised, a new study has found.

Air pollution can increase asthma risk in adults, even at low levels

November 24, 2017
Living close to a busy road can be bad for your respiratory health if you are middle aged, new Australian research has found.

Evidence found of oral bacteria contributing to bowel disorders

October 20, 2017
(Medical Xpress)—An international team of researchers has found evidence that suggests certain types of oral bacteria may cause or exacerbate bowel disorders. In their paper published in the journal Science, the group describes ...

New compound discovered in fight against inflammatory disease

September 22, 2017
A 10-year study by University of Manchester scientists for a new chemical compound that is able to block a key component in inflammatory illness has ended in success.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.