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

March 5, 2013

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

Targeting 'broken' metabolism in immune cells reduces inflammatory disease

July 12, 2017
The team, led by researchers at Imperial College London, Queen Mary University of London and Ergon Pharmaceuticals, believes the approach could offer new hope in the treatment of inflammatory conditions like arthritis, autoimmune ...

A perturbed skin microbiome can be 'contagious' and promote inflammation, study finds

June 29, 2017
Even in healthy individuals, the skin plays host to a menagerie of bacteria, fungi and viruses. Growing scientific evidence suggests that this lively community, collectively known as the skin microbiome, serves an important ...

Inflammatory bowel disease: Scientists zoom in on genetic culprits

June 28, 2017
Scientists have closed in on specific genes responsible for Inflammatory Bowel Disease (IBD) from a list of over 600 genes that were suspects for the disease. The team from the Wellcome Trust Sanger Institute and their collaborators ...

Trials show unique stem cells a potential asthma treatment

June 28, 2017
A study led by scientists at Monash University has shown that a new therapy developed through stem cell technology holds promise as a treatment for chronic asthma.

Researchers find piece in inflammatory disease puzzle

May 23, 2017
Inflammation is the process by which the body responds to injury or infection but when this process becomes out of control it can cause disease. Monash Biomedicine Discovery Institute (BDI) researchers, in collaboration with ...

Researchers reveal potential target for the treatment of skin inflammation in eczema and psoriasis

May 22, 2017
Superficially, psoriasis and atopic dermatitis may appear similar but their commonalities are only skin deep. Atopic dermatitis, also known as eczema, is primarily driven by an allergic reaction, while psoriasis is considered ...

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.