medwireNews: A comparison of different treatments for rheumatoid arthritis (RA) suggests that Janus kinase (JAK) inhibitors are associated with the highest risk for herpes zoster, while some biologic DMARDs may also be linked to an increased risk.
These findings are based on an analysis of data from 13,991 patients from the German RABBIT registry who initiated a JAK inhibitor, biologic, or conventional DMARD in 2007–2020.
In all, 533 people experienced 559 cases of herpes zoster during 62,958 person–years of follow-up, giving an overall event rate of 8.9 per 1000 person–years.
The exposure-adjusted event rate (EAER) of herpes zoster per 1000 person–years was highest for the 713 individuals treated with JAK inhibitors, at 21.5 events. For those taking biologics, the EAER ranged from 8.4 for the 817 patients on a T cell co-stimulation modulator to 10.3 for the 1431 on B cell-targeted therapies, and the EAER was 7.1 for the 3851 patients in the conventional DMARD group.
In a model adjusting for age, sex, and glucocorticoid use, and using inverse probability weights (IPW) to account for confounding by indication, people taking JAK inhibitors had a significant 3.66-fold increased risk for herpes zoster relative to those taking conventional DMARDs. Meanwhile, use of monoclonal anti-tumor necrosis factor (TNF) antibodies was associated with a 1.63-fold increased risk and B cell-targeted therapy with a 1.57-fold increased risk.
Treatment with a soluble TNF receptor fusion protein or an interleukin (IL)-6 inhibitor was associated with an increased risk for herpes zoster versus conventional DMARDs after adjustment for age, sex, and glucocorticoid use, but these associations lost statistical significance when IPW was also used.
Anja Strangfeld, from the German Rheumatism Research Centre in Berlin, and colleagues also found that age was significantly associated with herpes zoster risk, at a hazard ratio (HR) of 1.25 for each additional 10 years in the fully adjusted analysis. People taking glucocorticoids had a significantly higher risk than those who were not, with an HR of 1.47 for a daily dose of 5–10 mg and an HR of 4.42 for higher doses.
“In terms of a risk assessment with regard to vaccination, this suggests that especially elderly patients with higher glucocorticoid doses and patients for whom [JAK inhibitor] therapy is planned should be considered for vaccination,” write the researchers in the Annals of the Rheumatic Diseases.
“Preliminary data from tofacitinib-treated patients with RA indicate the possibility of reducing the risk of [herpes zoster] by vaccination,” they add.
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