Herpes zoster in patients treated with biologicals

Dermatology. 2012;224(3):251-6. doi: 10.1159/000338691. Epub 2012 Jun 1.

Abstract

Background: The incidence and severity of herpes zoster (HZ) appear increased in patients receiving tumor necrosis factor-α antagonists.

Objective: To study the incidence and clinical features of HZ in 1,220 patients (4,206 patient-years) receiving either adalimumab, etanercept, infliximab, rituximab or ustekinumab.

Results: Twenty-two HZ cases were identified [1.26% of total cohort; adalimumab: 11/1,546 patient-years, incidence rate (IR) 7.1; etanercept: 4/789 patient-years, IR 5.1; rituximab: 1/168 patient-years, IR 5.2; ustekinumab: 2/37 patient-years, IR 53.5; infliximab: 4/1,666 patient-years, IR 2.4]. The time to event varied widely (1.5- 108 months). Extensive HZ was reported in 45 and 32% of the cases, respectively. Persistent postzoster neuralgia (PHN; >6 months) was observed in 5/20 patients.

Conclusions: The HZ incidence was 2.1-fold higher among patients over 60 years, compared with a reference population, although not statistically significant. Severe, multidermatomal HZ and persistent PHN were common.

MeSH terms

  • Adult
  • Aged
  • Antirheumatic Agents / adverse effects*
  • Antirheumatic Agents / therapeutic use
  • Arthritis / drug therapy
  • Biological Products / adverse effects*
  • Biological Products / therapeutic use
  • Female
  • Herpes Zoster / chemically induced*
  • Herpes Zoster / epidemiology
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Neuralgia / chemically induced*
  • Neuralgia / epidemiology
  • Psoriasis / drug therapy
  • Retrospective Studies
  • Severity of Illness Index
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors

Substances

  • Antirheumatic Agents
  • Biological Products
  • Tumor Necrosis Factor-alpha