Document Detail

Association between the initiation of anti-tumor necrosis factor therapy and the risk of herpes zoster.
MedLine Citation:
PMID:  23462785     Owner:  NLM     Status:  MEDLINE    
IMPORTANCE: Herpes zoster reactivation disproportionately affects patients with rheumatoid arthritis (RA). It is unclear whether anti-tumor necrosis factor (anti-TNF) therapy elevates herpes zoster risk.
OBJECTIVES: To ascertain whether initiation of anti-TNF therapy compared with nonbiologic comparators is associated with increased herpes zoster risk.
DESIGN, SETTING, AND PATIENTS: We identified new users of anti-TNF therapy among cohorts of patients with RA, inflammatory bowel disease, and psoriasis, psoriatic arthritis, or ankylosing spondylitis from 1998 through 2007 within a large US multi-institutional collaboration combining data from Kaiser Permanente Northern California, Pharmaceutical Assistance Contract for the Elderly, Tennessee Medicaid, and national Medicaid/Medicare programs. We compared herpes zoster incidence between new anti-TNF users (n=33,324) and patients initiating nonbiologic disease-modifying antirheumatic drugs (DMARDs) (n=25,742) within each inflammatory disease cohort (last participant follow-up December 31, 2007). Within these cohorts, we used Cox regression models to compare propensity score-adjusted herpes zoster incidence between new anti-TNF and nonbiologic DMARD users while controlling for baseline corticosteroid use.
MAIN OUTCOME MEASURES: Incidence of herpes zoster cases occurring after initiation of new anti-TNF or nonbiologic DMARD therapy.
RESULTS: Among 33,324 new users of anti-TNF therapy, we identified 310 herpes zoster cases. Crude incidence rates among anti-TNF users were 12.1 per 1000 patient-years (95% CI, 10.7-13.6) for RA, 11.3 per 1000 patient-years (95% CI, 7.7-16.7) for inflammatory bowel disease, and 4.4 per 1000 patient-years (95% CI, 2.8-7.0) for psoriasis, psoriatic arthritis, or ankylosing spondylitis. Baseline use of corticosteroids of 10 mg/d or greater among all disease indications was associated with elevated risk (adjusted hazard ratio [HR], 2.13 [95% CI, 1.64-2.75]) compared with no baseline use. For patients with RA, adjusted incidence rates were similar between anti-TNF and nonbiologic DMARD initiators (adjusted HR, 1.00 [95% CI, 0.77-1.29]) and comparable between all 3 anti-TNF therapies studied. Across all disease indications, the adjusted HR was 1.09 (95% CI, 0.88-1.36).
CONCLUSION AND RELEVANCE: Among patients with RA and other inflammatory diseases, those who initiated anti-TNF therapies were not at higher risk of herpes zoster compared with patients who initiated nonbiologic treatment regimens.
Kevin L Winthrop; John W Baddley; Lang Chen; Liyan Liu; Carlos G Grijalva; Elizabeth Delzell; Timothy Beukelman; Nivedita M Patkar; Fenglong Xie; Kenneth G Saag; Lisa J Herrinton; Daniel H Solomon; James D Lewis; Jeffrey R Curtis
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  309     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-06     Completed Date:  2013-03-08     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  887-95     Citation Subset:  AIM; IM    
Division of Infectious Diseases, Public Health and Preventive Medicine, Oregon Health and Science University, OR 97239, USA.
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MeSH Terms
Antirheumatic Agents / adverse effects,  therapeutic use*
Arthritis, Rheumatoid / complications,  drug therapy*,  immunology
Autoimmune Diseases / complications,  drug therapy*,  immunology
Case-Control Studies
Cohort Studies
Databases, Factual
Herpes Zoster / chemically induced,  epidemiology*,  immunology
Immunocompromised Host
Middle Aged
Retrospective Studies
Tumor Necrosis Factor-alpha / antagonists & inhibitors*
United States / epidemiology
Grant Support
1K08HS017552-01/HS/AHRQ HHS; 5KL2 RR025776-03/RR/NCRR NIH HHS; 5P60AR56116/AR/NIAMS NIH HHS; AR053351/AR/NIAMS NIH HHS; K23 AR053351/AR/NIAMS NIH HHS; KL2 RR025776/RR/NCRR NIH HHS; P60 AR056116/AR/NIAMS NIH HHS; R01 HS018517/HS/AHRQ HHS; R01HS018517/HS/AHRQ HHS; U18 HS17919/HS/AHRQ HHS
Reg. No./Substance:
0/Antirheumatic Agents; 0/Tumor Necrosis Factor-alpha

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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