RESEARCH - Herpes zoster (shingles) in patients taking TNF-alpha antagonists for chronic inflammatory joint disease

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Joint Bone Spine. 2008 Oct;75(5):540-3. Epub 2008 Jul 31.

Herpes zoster in patients taking TNFalpha antagonists for chronic

inflammatory joint disease.

Wendling D, Streit G, Toussirot E, Prati C.

Service de Rhumatologie, CHU Minjoz et Université de Franche-Comté,

25030 Besançon, France.

OBJECTIVE: To assess the rate of occurrence and outcomes of herpes

zoster in patients taking TNFalpha antagonists.

METHODS: Retrospective review of the medical records of 300 patients

who received TNFalpha antagonists to treat chronic inflammatory joint

disease.

RESULTS: We identified 9 (9/300, 3%) patients who experienced herpes

zoster, 6 women and 3 men, with rheumatoid arthritis (n=7) or

ankylosing spondylitis (n=2). The drug was infliximab in 4 patients,

adalimumab in 2 patients, and etanercept in 3 patients, including 2

patients with a prior history of infliximab therapy (for 12 and 36

months, respectively). Mean treatment duration at the occurrence of

herpes zoster was 27 months (range, 6-42 months).

DISCUSSION: Glucocorticoid therapy (n=7) and methotrexate therapy

(n=6) were the only risk factors identified in our study. Mean

follow-up was 26 months. All 9 patients achieved a full recovery with

antiviral treatment and interruption of the TNFalpha antagonist. One

patient experienced a recurrence after resuming TNFalpha antagonist

therapy.

CONCLUSION: The scant data in the literature suggest a higher risk of

herpes zoster with anti-TNFalpha antibodies than with the soluble

receptor. The role for concomitant treatments (glucocorticoids and

methotrexate) should be taken into account.

PMID: 18674945

http://www.ncbi.nlm.nih.gov/pubmed/18674945

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