Shingles Stay Quiet with RA Medicine

TNF inhibitor therapy for rheumatoid arthritis may not impact herpes zoster outbreaks

(RxWiki News) Returning outbreaks of shingles are more common in people with rheumatoid arthritis (RA). Until now, researchers were not sure how medicines for RA would affect the chance that the painful rash would return.

Patients with RA have two to three times the risk of having shingles than individuals without RA.

Although anti-TNF medicines have been linked with certain infections, shingles outbreaks did not occur more often in RA patients who started taking anti-TNFs, according to a recently published study.

TNF inhibitors are often used to treat RA and other inflammatory diseases. They work by targeting cells in the body that cause inflammation.

"Ask your doctor about anti-TNF medications risks."

Shingles, also called herpes zoster, is a blistering and painful rash that comes and goes periodically. It comes back more often in patients with RA than individuals without the condition.

Researchers, led by Kevin Winthrop, MD, MPH, of Oregon Health and Science University in Portland, Oregon, aimed to see if starting anti-TNF therapy, a common treatment for RA, was linked with shingles outbreaks when compared to taking other medicines.

The study included data from four large medical databases of more than 33,300 patients who were new users of anti-TNF therapy between 1998 and 2007.

Anti-TNF therapy falls under a class of drugs called disease-modifying antirheumatic drugs (DMARDs). These medicines limit inflammation in the body.

Researchers compared the anti-TNF users to more than 25,700 patients who started taking non-biologic DMARDs for their conditions.

Participants had a variety of conditions, including inflammatory bowel disease, RA, psoriasis, psoriatic arthritis and ankylosing spondylitis.

Researchers compared the number of shingles cases among new users of anti-TNF medications and patients on the other medicines.

They found that the number of shingles cases were similar in both groups. In total, researchers identified 310 cases of shingles among anti-TNF users and 160 cases among the other group.

Within the RA group, the risk of having shingles was linked to being female, increasing age, overall health status and using higher doses of corticosteroids – another type of medication used to treat inflammatory diseases like RA.

"In summary, among patients with RA and other select inflammatory diseases, those who initiated anti-TNF therapies were not at higher risk of herpes zoster compared with patients who initiated nonbiologic treatment regimens," researchers wrote in their report.

The authors noted that the two groups in their study were all exposed to a medication containing methotrexate (Trexall). Researchers did not track how much each participant took, but they wrote they did not feel like it affected results.

The study was published March 6 in JAMA, the Journal of the American Medical Association.

The study was funded by the US Food and Drug Administration, US Department of Health and Human Services and the Agency for Healthcare Research and Quality (AHRQ) through the AHRQ Centers for Education and Research on Therapeutics Program.

The authors received honoraria, grant and research support for their work as consultants and for serving on the boards of numerous pharmaceutical companies. No other disclosures were reported.

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Review Date: 
March 9, 2013