Background/Purpose: Herpes zoster (HZ) infection is not uncommon in rheumatoid arthritis (RA) patients, especially in those treated with biologic or targeted synthetic (bts) disease-modifying antirheumatic drugs (DMARDs). Detailed analyses of HZ infection in Korean RA patients are limited, i.e. the relative risk of HZ infection compared with conventional (c) DMARD-treated patients.

Methods: By utilizing the data of the Korean college of Rheumatology Biologics Registry, or KOBIO, we investigated the incidence rate of HZ infection in the registered RA patients. We analyzed 1375 btsDMARD users (group 1), and 617 cDMARD-only users (group 2) registered from 2013 to 2017. The hazard ratio (HR) of HZ infection was adjusted for age, baseline corticosteroid usage, eGFR, and DAS28 (model 1), or age, gender, disease duration, baseline corticosteroid usage, comorbidity, smoking, eGFR, and DAS28 (model 2).

Results: Baseline characteristics of in both populations differed (group 1 vs. group 2) in disease activity (mean DAS28 5.67 vs. 3.33), disease duration (mean 7.7 vs. 6.4 years), dose of corticosteroids, and estimated GFR (eGFR). The overall incidence rate (per 100 patient × years) was 1.49 (95% CI 0.96 – 2.00) in group 1, and 0.90 (95% CI 0.53 – 1.46) in group 2; higher in RA patients treated with btsDMARDs. The unadjusted HR of HZ infection in group 1 in reference to group 2 was 1.562 (95% CI 0.874 – 2.791), and the adjusted HR by model 1 was 1.677 (95% CI 0.698 – 4.027), 1.695 (95% CI 0.707 – 4.063) by model 2.

Conclusion: These results indicate that the incidence rate of HZ infection in btsDMARD users may largely be driven by the baseline characteristics which these RA patients reserve, not only by the augmented immunosuppression they receive.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/incidence-rate-and-clinical-characteristics-of-herpes-zoster-infection-in-korean-patients-with-rheumatoid-arthritis-patients/