Soroka Medical Center, Beer-Sheva, Israel2Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel3Department of Quality Measurements and Research, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.
Carmel Medical Center, Haifa, Israel5Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
JAMA Dermatol. 2015 May;151(5):533-8. doi: 10.1001/jamadermatol.2014.4956.
The risk for herpes zoster (HZ) in patients with psoriasis treated with biologic medications or other systemic treatments has been given little attention to date.
To describe the risk for HZ in patients with psoriasis and its relation to treatment.
DESIGN, SETTING, AND PARTICIPANTS: A cohort study was performed using the administrative database of Clalit Health Services, the largest public health care provider organization in Israel, in the setting of general community clinics, primary care and referral centers, and ambulatory and hospitalized care. We extracted information for all patients who received a psoriasis diagnosis from January 2002 to June 2013. Follow-up was conducted until the end of July 2013. The study included 95,941 patients with psoriasis in the analysis, with 522,616 person-years of follow-up. Incidence of HZ events was calculated for each systemic antipsoriatic medication provided, during a follow-up period of 11 years and 7 months. We used a generalized estimating equation Poisson regression model to examine the effect of each systemic treatment for psoriasis on HZ incidence, adjusting for age, sex, psoriasis severity, Charlson comorbidity index, steroid treatment, and socioeconomic status.
Incidence of HZ associated with systemic therapies.
In a multivariate analysis, it was observed that treatment with phototherapy (rate ratio [RR], 1.09 [95% CI, 0.62-1.93]; P = .99), methotrexate (RR, 0.98 [95% CI, 0.78-1.23]; P = .83), cyclosporine (RR, 1.16 [95% CI, 0.48-2.80]; P = .49), and biologic medications as a single agent (RR, 2.67 [95% CI, 0.69-10.3]; P = .14) was not associated with HZ. The use of combination treatment with biologic medications and methotrexate was significantly associated with an increased incidence of HZ (RR, 1.66 [95% CI, 1.08-2.57]; P = .02). The use of acitritin was associated with decreased incidence of HZ (RR, 0.69 [95% CI, 0.49-0.97]; P = .004).
Physicians may need to consider offering an HZ preventive vaccine to patients receiving combination treatment with biologic medications and methotrexate, particularly if they have additional risk factors for HZ.
目前，人们对接受生物药物或其他全身治疗的银屑病患者发生带状疱疹（HZ）的风险关注甚少。
描述银屑病患者发生 HZ 的风险及其与治疗的关系。
设计、设置和参与者：本队列研究使用以色列最大的公共医疗保健组织克拉利特健康服务的行政数据库进行，在一般社区诊所、初级保健和转诊中心以及门诊和住院护理环境下开展。我们提取了 2002 年 1 月至 2013 年 6 月期间所有被诊断为银屑病的患者的信息。随访至 2013 年 7 月底。本研究共纳入 95941 例银屑病患者，随访 11 年零 7 个月。计算了在随访期间每种全身抗银屑病药物的 HZ 事件发生率。我们使用广义估计方程泊松回归模型，在校正年龄、性别、银屑病严重程度、Charlson 合并症指数、皮质类固醇治疗和社会经济状况后，分析每种全身治疗银屑病的方法对 HZ 发病率的影响。
与全身治疗相关的 HZ 发生率。
多变量分析显示，光疗（RR，1.09 [95%CI，0.62-1.93]；P = 0.99）、甲氨蝶呤（RR，0.98 [95%CI，0.78-1.23]；P = 0.83）、环孢素（RR，1.16 [95%CI，0.48-2.80]；P = 0.49）和作为单一药物的生物制剂（RR，2.67 [95%CI，0.69-10.3]；P = 0.14）治疗与 HZ 无相关性。生物制剂联合甲氨蝶呤的联合治疗与 HZ 发生率的增加显著相关（RR，1.66 [95%CI，1.08-2.57]；P = 0.02）。阿维 A 与 HZ 发生率降低相关（RR，0.69 [95%CI，0.49-0.97]；P = 0.004）。
如果患者有 HZ 的其他危险因素，医生可能需要考虑为接受生物制剂和甲氨蝶呤联合治疗的患者提供 HZ 预防疫苗。
