Herpes zoster in patients taking TNFalpha antagonists for chronic inflammatory joint disease.

Abstract

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.

• Authors: Daniel Wendling, Gérald Streit, Eric Toussirot, Clément Prati
• Journal: Joint bone spine (Joint Bone Spine) Vol. 75 Issue 5 Pg. 540-3 (Oct 2008) ISSN: 1778-7254 [Electronic] France
• PMID: 18674945 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents
• Antiviral Agents
• Glucocorticoids
• Immunoglobulin G
• Immunosuppressive Agents
• Receptors, Tumor Necrosis Factor
• Tumor Necrosis Factor-alpha
• Infliximab
• Adalimumab
• Valine
• Valacyclovir
• Etanercept
• Acyclovir
• Methotrexate

Topics

• Acyclovir (analogs & derivatives, therapeutic use)
• Adalimumab
• Adult
• Aged, 80 and over
• Antibodies, Monoclonal (adverse effects)
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents (adverse effects)
• Antiviral Agents (therapeutic use)
• Arthritis, Rheumatoid (complications, drug therapy)
• Drug Therapy, Combination
• Etanercept
• Female
• Glucocorticoids (adverse effects)
• Herpes Zoster (drug therapy, etiology)
• Humans
• Immunoglobulin G (adverse effects)
• Immunosuppressive Agents (adverse effects)
• Infliximab
• Male
• Methotrexate (adverse effects)
• Middle Aged
• Receptors, Tumor Necrosis Factor
• Retrospective Studies
• Risk Factors
• Spondylitis, Ankylosing (complications, drug therapy)
• Tumor Necrosis Factor-alpha (antagonists & inhibitors)
• Valacyclovir
• Valine (analogs & derivatives, therapeutic use)