In a nutshell
This study investigated whether exposure to tumor necrosis factor alpha (TNFalpha) inhibitors increases the risk of herpes zoster (shingles) in rheumatoid arthritis patients.
Some background
Biologics (medicines extracted from biological sources, such as cells, that block immune responses) have significantly improved outcomes for rheumatoid arthritis patients. TNFalpha inhibitors were the first biologics to be used in rheumatoid arthritis. There are now five TNFalpha inhibitors available for use. These include infliximab (Remicade), adalimumab (Humira), etanercept (Enbrel), golimumab (Simponi) and certolizumab pegol (Cimzia).
As a result of their success over 25% of rheumatoid arthritis patients in the US are estimated to be using biologics. However, because biologics modulate the immune system patients may have an increased risk of infection. Shingles is a painful disease cause by reactivation of the varicella-zoster virus (the virus that initially causes chickenpox). People with rheumatoid arthritis have an increased risk of shingles in comparison with the general population. However, whether or not the use of TNFalpha inhibitors increases the risk even further remains unclear.
Methods & findings
This study included results from 1870 patients with rheumatoid arthritis. Patients were mailed questionnaires relating to whether they had any previous episode of shingles. If patients responded with a “yes” to having a previous episode of shingles it was confirmed with their doctor.
In total 442 (23.6%) participants reported at least one episode of shingles. Of these 442 participants, 90 (20.4%) reported more than one episode of shingles. It was possible to verify 249 cases of shingles with patients’ doctors.
297 patients did not receive a biologic, 733 patients received etanercept, 522 patients received adalimumab and 88 patients received infliximab. Overall, treatment with TNFalpha inhibitors increased the risk of shingles by 71%. Patients treated with adalimumab had the highest risk, 2.3 times higher than for patients never exposed to TNFalpha inhibitors. Neither infliximab nor etanercept significantly increased the risk of shingles.
The bottom line
The authors concluded that TNFalpha inhibitors increase the risk of shingles in rheumatoid arthritis patients. They also suggest that patient education would help early diagnosis and treatment of shingles.
What’s next?
Please discuss with your physician any concerns you may have regarding shingles.
Published By :
Internal medicine journal
Date :
Jan 06, 2015
