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The risk of new H zoster infection was studied among nearly 30,000 new biologic starts and compared rates seen with abatacept, adalimumab, rituximab, infliximab, etanercept, tocilizumab, certolizumab or golimumab initiation. Rates ranged from 1.61-2.45 events per 100 patient-years and in these older patients with RA, the HZ risk was similar across biologic agents, including those with different MOAs.
Other studies have shown that HZ rates are increased when comparing patients treated with TNF inhibitors versus oral DMARDs. Hence, whether HZ rates are increased or not depends upon who the comparator population is. For example when compared to placebo, RA patients treated with tofacitinib have rates of ~4.5 events per 100 patient years.