Herpes zoster in patients taking TNFalpha antagonists for chronic inflammatory joint disease.

OBJECTIVE

To assess the rate of occurrence and outcomes of herpes zoster in patients taking TNFalpha antagonists.

METHODS

Retrospective review of the medical records of 300 patients who received TNFalpha antagonists to treat chronic inflammatory joint disease.

RESULTS

We identified 9 (9/300, 3%) patients who experienced herpes zoster, 6 women and 3 men, with rheumatoid arthritis (n=7) or ankylosing spondylitis (n=2). The drug was infliximab in 4 patients, adalimumab in 2 patients, and etanercept in 3 patients, including 2 patients with a prior history of infliximab therapy (for 12 and 36 months, respectively). Mean treatment duration at the occurrence of herpes zoster was 27 months (range, 6-42 months).

DISCUSSION

Glucocorticoid therapy (n=7) and methotrexate therapy (n=6) were the only risk factors identified in our study. Mean follow-up was 26 months. All 9 patients achieved a full recovery with antiviral treatment and interruption of the TNFalpha antagonist. One patient experienced a recurrence after resuming TNFalpha antagonist therapy.

CONCLUSION

The scant data in the literature suggest a higher risk of herpes zoster with anti-TNFalpha antibodies than with the soluble receptor. The role for concomitant treatments (glucocorticoids and methotrexate) should be taken into account.