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, according to a new study in the JAMA.
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. Herpes zoster is one of the most common adverse events reported in clinical trials of anti–TNF-α agents, according to background information in the article. Patients with rheumatoid arthritis are at increased risk of herpes zoster compared with the general population.
Anja Strangfeld, M.D., of the German Rheumatism Research Center, Berlin, and colleagues investigated the association of various rheumatoid arthritis treatments, including anti–TNF-α therapy, with the risk of herpes zoster. A total of 5,040 patients were included in the analysis.Treatment, clinical status and adverse events were assessed by rheumatologists at fixed points during follow-up (of up to three years).
A significantly higher risk of developing herpes zoster was found for patients of older age and for treatment with glucocorticoids (steroid hormones that are widely used as anti-inflammatory medications).
“Based on our data, we recommend careful monitoring of patients treated with monoclonal anti–TNF-α antibodies for early signs and symptoms of herpes zoster,” the authors conclude.