Rheumatoid Arthritis Meds Associated With Increased Shingles Risk

http://www.elements4health.com/rheumatoid-arthritis-meds-associated-with-increased-shingles-risk.html

• According to a study, use of certain medications known as monoclonal anti– tumor necrosis factor α (TNF-α) antibodies for the treatment of rheumatoid arthritis appears to be associated with an increased risk for herpes zoster (shingles), the painful infection characterized by blisters.

• Rheumatoid arthritis is an inflammatory disease that attacks the synovium lining of the joints, causing pain, swelling, stiffness, and loss of function. There is no cure for rheumatoid arthritis.

• Patients with rheumatoid arthritis are at increased risk of herpes zoster compared with the general population. Herpes zoster is one of the most common adverse events reported in clinical trials of anti–TNF-α agents.

• There has been evidence from some studies that patients treated with anti–TNF-α agents are at an increased risk of bacterial infections, but little is known about the risk of viral infections, such as herpes zoster, in patients with rheumatoid arthritis receiving these types of medications. 

• Anja Strangfeld and colleagues investigated the association of various rheumatoid arthritis treatments, including anti–TNF-α therapy, with the risk of herpes zoster. The researchers analyzed data from patients who began treatment with adalimumab or infliximab (monoclonal anti–TNF-α antibodies), etanercept (a fusion protein), the monotherapeutic agent anakinra, or when patients changed conventional disease-modifying anti-rheumatic drug (DMARD). Treatment, clinical status and adverse events were assessed by rheumatologists at fixed points during follow-up (of up to three years). A total of 5,040 patients were included in the analysis.

• There were 86 cases of herpes zoster among 82 patients. Thirty-nine occurrences could be attributed to treatment with anti–TNF-α antibodies (23 to etanercept, 24 to conventional DMARDs). The researchers found a significant association between herpes zoster and treatment with the monoclonal anti–TNF-α antibodies infliximab and adalimumab, although this risk was lower than the threshold for clinical significance. There was no significant association between herpes zoster and treatment with etanercept, or anti–TNF-α treatment as a class. 

• A significantly higher risk of developing herpes zoster was found for rheumatoid arthritis patients of older age and for treatment with glucocorticoids (steroid hormones that are widely used as anti-inflammatory medications).