Lim Doo-Ho, Kim Ye-Jee, Kim Seon Ok, Hong Seokchan, Lee Chang-Keun, Yoo Bin, Kim Yong-Gil
a Division of Rheumatology, Department of Internal Medicine , University of Ulsan College of Medicine, Ulsan University Hospital , Ulsan , Republic of Korea.
b Department Clinical Epidemiology and Biostatistics , Asan Medical Center , Seoul , Republic of Korea.
Mod Rheumatol. 2018 Jan;28(1):168-173. doi: 10.1080/14397595.2017.1325034. Epub 2017 May 26.
The aims of our study were to determine whether the use of conventional disease-modifying antirheumatic drugs (cDMARDs) or tumor necrosis factor α (TNFα) inhibitors increase the risk of herpes zoster (HZ) in patients with ankylosing spondylitis (AS).
We searched the South Korean National Health Insurance Service - National Sample Cohort Database for relevant patient records between 2002 and 2013. We evaluated the incidence of HZ by categorizing patients into in three treatment groups: disease-modifying antirheumatic drug (DMARD) nonusers, cDMARD users and TNFα inhibitor users.
Incidence rates of HZ was 11.0 per 1000 person-years in patients with AS. The adjusted hazard ratio of HZ was higher in cDMARD and TNFα inhibitor users than in DMARD nonusers. In subgroup analyses, current treatment with a TNFα inhibitor increased the risk of HZ significantly both in female patients and in patients aged 50 years or older, but not in patients taking steroids, compared to DMARD nonusers.
Treatment with either TNFα inhibitors or cDMARDs is associated with a higher risk of HZ, especially in female patients and older patients, and these two patient groups could therefore benefit from HZ vaccination.
我们研究的目的是确定使用传统抗风湿药物（cDMARDs）或肿瘤坏死因子α（TNFα）抑制剂是否会增加强直性脊柱炎（AS）患者发生带状疱疹（HZ）的风险。
我们在韩国国民健康保险服务 - 全国样本队列数据库中搜索了2002年至2013年期间的相关患者记录。我们通过将患者分为三个治疗组来评估HZ的发病率：未使用抗风湿药物（DMARD）的患者、使用cDMARD的患者和使用TNFα抑制剂的患者。
AS患者中HZ的发病率为每1000人年11.0例。使用cDMARD和TNFα抑制剂的患者中HZ的调整后风险比高于未使用DMARD的患者。在亚组分析中，与未使用DMARD的患者相比，当前使用TNFα抑制剂治疗在女性患者和50岁及以上患者中显著增加了HZ的风险，但在服用类固醇的患者中未增加。
使用TNFα抑制剂或cDMARDs治疗均与HZ的较高风险相关，尤其是在女性患者和老年患者中，因此这两组患者可能会从HZ疫苗接种中受益。
