RESEARCH - The risk of shingles in patients with RA in the US and UK

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Arthritis Rheum. 2007 Dec 15;57(8):1431-8.

The risk of herpes zoster in patients with rheumatoid arthritis in the

United States and the United Kingdom.

Smitten AL, Choi HK, Hochberg MC, Suissa S, Simon TA, Testa MA, Chan KA.

Harvard School of Public Health, Boston, Massachusetts 02115, USA.

OBJECTIVE: To determine whether the incidence of herpes zoster is

elevated in patients with rheumatoid arthritis (RA) and whether herpes

zoster is associated with use of disease-modifying antirheumatic drugs

(DMARDs) in patients with RA. METHODS: Two retrospective cohort

studies were conducted using data from a US integrated managed care

database (PharMetrics claims database) from 1998-2002 and the UK

General Practice Research Database (GPRD) between 1990-2001. Rates of

herpes zoster among patients with RA and randomly sampled non-RA

patients were compared. A nested case-control analysis was performed

within each RA cohort to examine the effect of current treatment on

herpes zoster risk. RESULTS: A total of 122,272 patients with RA from

the PharMetrics database and 38,621 from the GPRD were included. The

adjusted hazard ratios of herpes zoster for patients with RA compared

with non-RA patients were 1.91 (95% confidence interval [95% CI]

1.80-2.03) in the PharMetrics database and 1.65 (95% CI 1.57-1.75) in

the GPRD. In the PharMetrics database, current use of biologic DMARDs

alone was associated with herpes zoster (odds ratio [OR] 1.54, 95% CI

1.04-2.29), as was current use of traditional DMARDs alone (OR 1.37,

95% CI 1.18-1.59). In the GPRD, current use of traditional DMARDs was

associated with herpes zoster (OR 1.27, 95% CI 1.10-1.48). In both

data sources, use of oral corticosteroids was associated with herpes

zoster regardless of concomitant therapies.

CONCLUSION: Data from 2 large databases suggested that patients with

RA are at increased risk of herpes zoster. Among patients with RA,

DMARDs and/or use of oral corticosteroids appeared to be associated

with herpes zoster.

PMID: 18050184

http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve & db=PubMed & list_uids=180501\

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