Type of Rheumatoid Arthritis Medication (Humira, Remicade) May Increase Risk for Shingles

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Type of Rheumatoid Arthritis Medication May Increase Risk for Shingles

www.newswise.com/articles/view/549137/

Use of certain medications known as monoclonal anti- tumor necrosis factor a

(TNF-a) antibodies for the treatment of rheumatoid arthritis appears to be

associated with an increased risk for herpes zoster (shingles), the painful

infection characterized by blisters, according to a study in the February 18

issue of JAMA.

There has been evidence from some studies that patients treated with

anti-TNF-a agents are at an increased risk of bacterial infections, but

little is known about the risk of viral infections, such as herpes zoster,

in patients with rheumatoid arthritis receiving these types of medications.

Herpes zoster is one of the most common adverse events reported in clinical

trials of anti-TNF-a agents, according to background information in the

article.

Patients with rheumatoid arthritis are at increased risk of herpes zoster

compared with the general population.

Anja Strangfeld, M.D., of the German Rheumatism Research Center, Berlin, and

colleagues investigated the association of various rheumatoid arthritis

treatments, including anti-TNF-a therapy, with the risk of herpes zoster.

The researchers analyzed data from patients who began treatment with

adalimumab or infliximab (monoclonal anti-TNF-a antibodies), etanercept (a

fusion protein), the monotherapeutic agent anakinra, or when patients

changed conventional disease-modifying anti-rheumatic drug (DMARD).

Treatment, clinical status and adverse events were assessed by

rheumatologists at fixed points during follow-up (of up to three years). A

total of 5,040 patients were included in the analysis.

There were 86 cases of herpes zoster among 82 patients. Thirty-nine

occurrences could be attributed to treatment with anti-TNF-a antibodies (23

to etanercept, 24 to conventional DMARDs). The researchers found a

significant association between herpes zoster and treatment with the

monoclonal anti-TNF-a antibodies infliximab and adalimumab, although this

risk was lower than the threshold for clinical significance. There was no

significant association between herpes zoster and treatment with etanercept,

or anti-TNF-a treatment as a class.

A significantly higher risk of developing herpes zoster was found for

patients of older age and for treatment with glucocorticoids (steroid

hormones that are widely used as anti-inflammatory medications).

" Based on our data, we recommend careful monitoring of patients treated with

monoclonal anti-TNF-a antibodies for early signs and symptoms of herpes

zoster, " the authors conclude.

(JAMA. 2009;301[7]:737-744. Available pre-embargo to the media at

www.jamamedia.org)

Editor's Note: Please see the article for additional information, including

other authors, author contributions and affiliations, financial disclosures,

funding and support, etc.

Editorial: Herpes Zoster in the Age of Focused Immunosuppressive Therapy

In an accompanying editorial, J. Whitley, M.D., and W. Gnann

Jr., M.D., of the University of Alabama at Birmingham, comment on the

findings of this study.

" The TNF-a inhibitors provide tremendous benefit to a broad spectrum of

patients with systemic inflammatory diseases. As with any therapy, time is

required for all of the safety concerns related to these potent medications

to become apparent. TNF-a 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. "

(JAMA. 2009;301[7]:774-775. Available pre-embargo to the media at

www.jamamedia.org)

Editor's Note: Please see the article for additional information, including

other authors, author contributions and affiliations, financial disclosures,

funding and support, etc.