Anti-TNFs increase risk for herpes zoster infections in IRD patients

By Ingrid Grasmo

Patients with inflammatory rheumatic diseases (IRD) who are treated with anti-tumor necrosis factor (anti-TNF) medications are significantly more likely to experience herpes zoster infections than those treated with traditional disease-modifying anti-rheumatic drugs (DMARDs), study results show.

Herpes zoster, also known as shingles, is a painful, blistering skin rash linked to varicella-zostervirus - the same virus that causes chickenpox. Infections are usually treated with antiviral medication and corticosteroids to reduce swelling, but pain left after the infection can last for months or years. In addition, the virus can also result in temporary or permanent paralysis in more serious cases.

"Anti-TNFs, such as infliximab, adalimumab, and etanercept have become the treatment of choice for patients with inflammatory rheumatic diseases who are uncontrolled on traditional DMARDs, but it is know that side effect of these drugs is an increased risk for bacterial infections," said lead study author Helene Che (Lapeyronie Hospital, Montpellier, France) in an associated press release.

To assess the risk for herpes zoster infections in patients with IRD treated with TNF blockers, Che and team performed a review of 50 studies reporting respective incidences of herpes infections in this patient group.

In total, five studies were included in the meta-analysis to allow calculation of a pooled estimate for the relative risk for herpes infection, with a total follow-up of 124,966 patient-years.

Based on the data from the five studies, IRD patients treated with anti-TNF medication had a 1.75-fold increased risk for herpes infection compared with patients treated with traditional DMARDs.

The proportion of severe herpes infections was greater among German populations relative to the US population, at 20.9% versus 4.9%. In the British registry, the respective rates were 6% and 0.02% with anti-TNFs and DMARDs.

"Careful monitoring of patients treated with anti-TNFs is required for early signs and symptoms of herpes zoster and raises the issue as to when vaccination against the virus should occur," said Che.

The findings were presented at the Annual European Congress of Rheumatology in Berlin, Germany.

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