Session Information
Date: Sunday, November 8, 2015
Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy Poster I
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Patients with rheumatoid arthritis (RA) are at increased risk for herpes zoster (HZ) infection. RA treatment including immunosuppressant medications could further exacerbate the risk. The aim of this study was to investigate the effects of conventional (cDMARDs) and biologic disease-modifying antirheumatic drugs (bDMARDs) on the risks of HZ infection in RA patients.
Methods: In this retrospective cohort study, a total of 277 RA patients were enrolled, who ever received bDMARDs at Seoul National University Hospital between August 2003 to February 2015. Among the enrolled patients, 718 treatment episodes of cDMARDs and bDMARDs were identified, which included infliximab, etanercept, adalimumab, golimumab, rituximab, abatacept, and tocilizumab. Baseline information included demographics, disease duration, comorbidity, smoking history, rheumatoid factor, anti-CCP antibodies, erythrocyte sedimentation rate, C-reactive protein, and concomitant cDMARDs at initiation of treatment. After identifying all episodes of HZ infection, crude incidence rates of HZ per 100 patient-years (95% confidence intervals [CI]) were calculated.
Results: Among 718 treatment courses, 277 (38.6%) used cDMARDs, 66 (9.2%) infliximab, 175 (24.4%) etanercept, 95 (13.2%) adalimumab, 9 (1.3%) golimumab, 41 (5.7%) rituximab, 31 (4.3%) abatacept, and 24 (3.3%) tocilizumab. A total of thirty-one episode of HZ occurred, sixteen occurred in cDMARDs treatment courses and twenty-one occurred in bDMARDs, 2 infliximab, 8 etanercept, 5 adalimumab, 3 rituximab, and 3 abatacept. The crude incidence rate per 100 patient-years was 2.4 (95% CI, 1.4-3.9) for cDMARDs, 2.2 (0.3-7.9) for infliximab, 1.8 (0.8-3.6) for etanercept, 3.7 (1.2-8.4) for adalimumab, 3.9 (0.8-11.0) for rituximab, and 8.5 (1.8-23.1) for abatacept (Table 1).
Conclusion: bDMARDs do not always increase the risk of HZ infection in RA patients, although HZ infection rates vary between different bDMARDs.
Table 1. Crude incidence Rates of Herpes Zoster Events per 100 patient-years
|
Observed patient-years |
Herpes zoster Events number |
100 patient-years |
95% CI |
|
|
Total (n=718) |
1470.2 |
37 |
2.5 |
1.8-3.5 |
|
cDMARDs (n=277) |
662.1 |
16 |
2.4 |
1.4-3.9 |
|
Infliximab (n=66) |
89.8 |
2 |
2.2 |
0.3-7.9 |
|
Etanercept (n=175) |
440.3 |
8 |
1.8 |
0.8-3.6 |
|
Adalimumab (n=95) |
135.9 |
5 |
3.7 |
1.2-8.4 |
|
Golimumab (n=9) |
11.2 |
0 |
0.0 |
0-28.5 |
|
Rituximab (n=41) |
77.1 |
3 |
3.9 |
0.8-11.0 |
|
Abatacept (n=31) |
35.5 |
3 |
8.5 |
1.8-23.1 |
|
Tocilizumab (n=24) |
18.3 |
0 |
0.0 |
0-18.5 |
Abbreviations: cDMARDs, conventional disease-modifying antirheumatic drugs; CI, confidence interval
To cite this abstract in AMA style:
Kwon HM, Lee SJ, Yang JA, Moon JY, Ahn EY, Park JK, Lee EY, Song YW, Lee EB. Risk of Herpes Zoster in Patients with Rheumatoid Arthritis Treated with Biologic Disease-Modifying Therapy Compared with Conventional Therapy [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/risk-of-herpes-zoster-in-patients-with-rheumatoid-arthritis-treated-with-biologic-disease-modifying-therapy-compared-with-conventional-therapy/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-of-herpes-zoster-in-patients-with-rheumatoid-arthritis-treated-with-biologic-disease-modifying-therapy-compared-with-conventional-therapy/