Yun Huifeng, Xie Fenglong, Delzell Elizabeth, Chen Lang, Levitan Emily B, Lewis James D, Saag Kenneth G, Beukelman Timothy, Winthrop Kevin, Baddley John W, Curtis Jeffrey R
University of Alabama at Birmingham.
Arthritis Care Res (Hoboken). 2015 May;67(5):731-6. doi: 10.1002/acr.22470.
To evaluate whether the risks of herpes zoster (HZ) differed by biologic agents with different mechanisms of action (MOAs) in older rheumatoid arthritis (RA) patients.
Using Medicare data from 2006-2011, among RA patients with prior biologic agent use and no history of cancer or other autoimmune diseases, this retrospective cohort study identified new treatment episodes of abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab. Followup started on initiation of the new biologic agent and ended at any of the following: first incidence of HZ, a 30-day gap in current exposure, death, a diagnosis of other autoimmune disease or cancer, loss of insurance coverage, or December 31, 2011. We calculated the proportion of RA patients vaccinated for HZ in each calendar year prior to biologic agent initiation and HZ incidence rate for each biologic agent. We compared HZ risks among therapies using Cox regression adjusted for potential confounders.
Of 29,129 new biologic treatment episodes, 28.7% used abatacept, 15.9% adalimumab, 14.8% rituximab, 12.4% infliximab, 12.2% etanercept, 6.1% tocilizumab, 5.8% certolizumab, and 4.4% golimumab. The proportion of RA patients vaccinated for HZ prior to biologic agent initiation ranged from 0.4% in 2007 to 4.1% in 2011. We identified 423 HZ diagnoses with the highest HZ incidence rate for certolizumab (2.45 per 100 person-years) and the lowest for golimumab (1.61 per 100 person-years). Neither the crude incidence rate nor the adjusted hazard ratio differed significantly among biologic agents. Glucocorticoid use had a significant association with HZ.
Among older patients with RA, the HZ risk was similar across biologic agents, including those with different MOAs.
评估在老年类风湿关节炎（RA）患者中，不同作用机制（MOA）的生物制剂所致带状疱疹（HZ）风险是否存在差异。
利用2006 - 2011年医疗保险数据，在既往使用过生物制剂且无癌症或其他自身免疫性疾病病史的RA患者中，这项回顾性队列研究确定了阿巴西普、阿达木单抗、赛妥珠单抗、依那西普、戈利木单抗、英夫利昔单抗、利妥昔单抗和托珠单抗的新治疗疗程。随访从新生物制剂开始使用时开始，至以下任何一种情况结束：HZ首次发病、当前暴露有30天的间隔、死亡、诊断出其他自身免疫性疾病或癌症、失去保险覆盖，或2011年12月31日。我们计算了生物制剂开始使用前各日历年中接种HZ疫苗的RA患者比例以及每种生物制剂的HZ发病率。我们使用经潜在混杂因素调整的Cox回归比较了各治疗方法之间的HZ风险。
在29,129个新的生物治疗疗程中，28.7%使用阿巴西普，15.9%使用阿达木单抗，14.8%使用利妥昔单抗，12.4%使用英夫利昔单抗，12.2%使用依那西普，6.1%使用托珠单抗，5.8%使用赛妥珠单抗，4.4%使用戈利木单抗。生物制剂开始使用前接种HZ疫苗的RA患者比例在2007年为0.4%至2011年为4.1%之间。我们确定了42³例HZ诊断病例，赛妥珠单抗的HZ发病率最高（每100人年2.45例），戈利木单抗的HZ发病率最低（每100人年1.61例）。生物制剂之间的粗发病率和调整后的风险比均无显著差异。使用糖皮质激素与HZ有显著关联。
在老年RA患者中，包括那些具有不同MOA的生物制剂，其HZ风险相似。
