Combination therapy with biologics and methotrexate increased the risk for herpes zoster among people receiving treatment for psoriasis, while single-agent therapy with biologics or methotrexate did not, according to new data.
“These data appear to be consistent with findings reported in studies of diseases other than psoriasis,” the researchers wrote in JAMA Dermatology. “Physicians, as well as patients treated with biologic medications together with methotrexate, at a minimum, should be aware of the risk of herpes zoster associated with these treatments. Because early treatment of herpes zoster may decrease the severity of symptoms and the incidence of complications, it is important to alert patients about the hazard of developing herpes zoster.”
Researchers from Clalit Health Services in Israel conducted a cohort study by extracting information about all patients diagnosed with psoriasis from January 2002 to June 2013. The analysis included 95,941 patients and 522,616 person-years of follow-up. The researchers calculated the herpes zoster incidence for each systemic psoriasis medication.
The total crude incidence rate was 8.9 per 1,000 patient-years for the entire population. The incidence during the treatment-free periods (control) was 8.8 per 1,000 patient-years and the incidence among the treated patients was 11.1 per 1,000 patient-years. In a multivariable analysis, no single therapy or agent, including phototherapy, methotrexate, cyclosporine or biologic, was associated with an increased incidence of herpes zoster.
The combination of biologic medications with methotrexate increased the incidence of herpes zoster (RR = 1.66; 95% CI, 1.08-2.57). Other factors associated with an increased risk for herpes zoster included age at baseline, female sex, use of corticosteroids, high and intermediate socioeconomic status, Charlson comorbidity index and psoriasis severity.
“Dermatologists treating patients with combination treatment … may need to consider offering herpes zoster vaccine to patients who receive such drugs, particularly if they have other risk factors for developing herpes zoster,” the researchers wrote. “The live-attenuated herpes zoster vaccine, if administered, should be given before initiation of systemic or biologic treatments that increase risk of herpes zoster.” – by Emily Shafer
Disclosure: Shalom reports no relevant financial disclosures. Please see the full study for a full list of all other authors’ relevant financial disclosures.