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Specific RA medication may be linked to a higher risk for shingles

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Using monoclonal anti-tumor necrosis factor-alpha antibodies for the treatment of rheumatoid arthritis (RA) may be associated with an increased risk for herpes zoster, according to a new German study appearing in the Feb. 18 issue of the Journal of the American Medical Association (JAMA).

To investigate the potential link between tumor necrosis factor-alpha (TNF-alpha) inhibitors and the high rate of herpes zoster in patients with RA, Anja Strangfeld, MD, of the German Rheumatism Research Center in Berlin, and colleagues studied 5,040 patients who changed their conventional disease-modifying antirheumatic drug (DMARD) treatment or who started treatment with the following:

• the monoclonal anti-TNF-alpha antibodies adalimumab (Humira, Abbott) or infliximab (Remicade, Centocor);
• the fusion protein etanercept (Enbrel, Amgen and Wyeth Pharmaceuticals); or
• the monotherapeutic agent anakinra (Kineret, Biovitrum).

The investigators assessed the clinical status, treatment and adverse events of the patients at fixed intervals during a follow-up of up to 3 years, according to a press release of the study.

They discovered 86 instances of herpes zoster among 82 patients. The investigators attributed 39 cases to treatment with anti-TNF-alpha antibodies, 23 cases to etanercept and 24 instances to conventional DMARDs. They also found a significant link between herpes zoster and treatment with adalimumab and infliximab. However, this risk was below the threshold for clinical significance, according to the press release.

In addition, the research revealed no significant association between herpes zoster and etanercept treatment or anti-TNF-alpha treatment as a class. However, the study showed a significantly higher risk for herpes zoster among patients treated with glucocorticoids and older patients, according to the release.

“Based on our data, we recommend careful monitoring of patients treated with monoclonal anti-TNF-alpha antibodies for early signs and symptoms of herpes zoster,” the investigators wrote.

“The TNF-alpha inhibitors provide tremendous benefit to a broad spectrum of patients with systemic inflammatory diseases,” Richard J. Whitley, MD, and John W. Gnann Jr., MD, of the University of Alabama at Birmingham, wrote in a JAMA editorial accompanying the study.

“As with any therapy, time is required for all of the safety concerns related to these potent medications to become apparent. TNF-alpha inhibitors have revolutionized the management of a number of difficult diseases, especially inflammatory arthritis, but clinicians must continue to remain aware of the potential for serious infectious complications, which now include herpes zoster,” they wrote.

For more information:

• The investigators have no financial disclosures related to this study. The study was supported by grants from Essex Pharma, Wyeth Pharmaceuticals, Amgen, Abbott, Hoffman-La Roche and Bristol-Myers Squibb.

Reference:

• Strangfeld A, Listing J, Herser P, et al. Risk of herpes zoster in patients with rheumatoid arthritis treated with anit-TNF-alpha agents. J Am Med Assoc. 2009;301[7]:774-775.