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Shingles Risk with JAK Inhibitors and Other Biologics

Jul 29, 2021 4:48 pm

Registry data suggests an increased risk of herpes zoster (HZ, shingles) in rheumatoid arthritis (RA) patients taking JAK inhibitors (JAKi) but also with other biologic DMARDs, compared to csDMARDs.

RA patients from the German RABBIT register were prospectively enrolled (2007 - 2020) and safety events were ascertained, including HZ events.

Among 13 991 RA patients studied for 62 958 patient-yearspy) a total of 559 HZ events occurred; the HZ risks were as follows: 

  • JAKi or tsDMARDs (21.5, 95% CI 16.4 to 27.9)\
  • Rituximab (10.3, 95% CI 8.0 to 13.0)
  • anti-TNF antibodies (9.3, 95% CI 7.7 to 11.2)
  • Interleukin 6 inhibitors (8.8, 95% CI 6.9 to 11.0)
  • Etanercept (8.6, 95% CI 6.8 to 10.8)
  • Abatacept (8.4, 95% CI 5.9 to 11.8)
  • csDMARDs (7.1, 95% CI 6.0 to 8.3).

After adjustments, JAKi had the greatest overall risk - 3 fold higher than traditional oral DMARDs (HR 3.66, 95% CI 2.38 to 5.63).  Whereas anti-TNF antibodies (HR 1.63) and RTX (HR 1.57) also increased HZ risk, other biologics did not (ETN, ABA, IL-6 inhibitors)compared with csDMARDs.

Disclosures
The author has no conflicts of interest to disclose related to this subject

Rheumatologists’ Comments

Keshav Raj Sigdel

| Aug 02, 2021 10:57 pm

What is the probability of herpes zoster infection when patient is in combination of tofacitinib with methotrexate ?
Do we need to stop tofacitinib for a while during zoster treatment.

Based on other studied with Tofa and other JAK inhibitors, the Shingles risk for Tofa+MTX is the same as TOFA monotherapy, which is 3-4times higher than RA on MTX monotherapy. Hence the major risk with new drugs is with all the JAK inhibitors. The newly approved SLE drug, anifrolumab will have a high risk of Shingles, like the JAK inhibitors.

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