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Biologics associated with increased risk for herpes zoster in immunocompromised patients
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Patients who took biologics to treat autoimmune diseases showed an increased risk for herpes zoster infection, according to data from a meta-analysis.
“There are multiple studies reporting the risk of herpes zoster associated with individual immunosuppressants in patients with … rheumatoid arthritis, psoriasis, psoriatic arthritis, systemic lupus erythematosus and inflammatory bowel disease,” Fawziah Marra, PharmD, a pharmacy professor at the University of British Columbia, and colleagues wrote. “However, the results are conflicting and statistical significance is often not detected due to the low incidence of herpes zoster.”
Using multiple databases, the researchers identified 4,225 studies on herpes zoster infection in immunocompromised patients conducted between January 1946 and February 2016. Of these, 28 randomized controlled trials (RCTs; n = 12,272) and six observational studies (n = 132,647) reported the relationship between herpes zoster risk and the use of biologics compared with controls or no therapy.
Marra and colleagues reported biologics were associated with a higher risk compared with controls in the RCTs (OR = 1.71; 95% CI, 1.11-2.64) and observational studies (OR = 1.58; 95% CI, 1.39-1.81). The RCTs indicated that nontumor necrosis factor-alpha blockers produced an increased risk for herpes zoster infection (OR = 2.19; 95% CI, 1.2-4.02), while TNF blockers were not significantly different from controls. The observational studies showed nonbiologic disease-modifying antirheumatic drugs were associated with an increased risk for herpes zoster infection (OR = 1.21; 95% CI, 1.15-1.28), as were corticosteroids (OR = 1.73; 95% CI, 1.57-1.89). However, few RCTs examined those comparisons, the researchers noted.
“We demonstrated an increased risk of herpes zoster in immunocompromised patients receiving biologics, especially non-TNF-alpha blockers,” Marra and colleagues wrote. “Increased herpes zoster risk from corticosteroid and nonbiologic disease-modifying antirheumatic drug use was also observed in observational studies.
“Finally, not all biological agents are equal with respect to their potential for opportunistic infections and post-marketing surveillance of these newer agents with different mechanisms of action than the traditional TNF-alpha inhibitors is vital.” – by Andy Polhamus
Disclosure: Marra reports receiving unrestricted grants from Merck Canada, which provided funding for the study. The other researchers report no relevant financial disclosures.
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