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We read with interest the report by Galloway et al1 on the risk of skin and soft tissue infections (including shingles) in patients exposed to tumour necrosis factor (TNF) antagonists from the British Society of Rheumatology biologics register (BSRBR). In the light of our recently published systematic literature review of the risk of shingles in rheumatoid arthritis (RA) patients, we would like to address several issues raised in the report.2 The authors state that the incidence of shingles is 1.6/100 patient-year (PY) in the anti-TNF cohort compared with 0.8/100PY in the non-biologic disease modifying anti-rheumatic drug (nbDMARD) group. However, it is well established that RA patients have an inherently higher risk of shingles irrespective of treatment modality.3 In a retrospective analysis of data from a US managed care database (n=122 272) and a UK general practice research database (n=38 621), an increased risk of shingles was found among all patients with RA …
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