Tang Zhenwei, Shen Minxue, Chen Xiang
Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.
Hunan Engineering Research Center of Skin Health and Disease, Hunan Key Laboratory of Skin Cancer and Psoriasis (Xiangya Hospital), Changsha, China.
Front Med (Lausanne). 2021 Jun 4;8:665559. doi: 10.3389/fmed.2021.665559. eCollection 2021.
Herpes zoster (HZ) has raised public concern. An increasing incidence of HZ can be seen in the immunocompromised population, such as the psoriasis patients taking biologics. Real-world evidences are still needed to investigate the risks of HZ among patients receiving different biologics treatments. This study aims to summarize the findings from cohort studies. Herein, we performed a meta-analysis of cohort studies. We included studies referred to seven biologics (adalimumab, alefacept, efalizumab, etanercept, infliximab, rituximab, and ustekinumab) as well as methotrexate for psoriasis. We estimated summary relative risks (RRs) for HZ using pairwise and network meta-analysis. Overall, five studies were included for analysis. A total of 32827.6 patient-years were observed. The result of the meta-analysis showed that the pooled HZ incidence rate of adalimumab, which accounts for the most patient-years in our analysis, is 2.6 per 1,000 patient-years. Our analysis based on several cohorts showed an insignificant difference among the patients receiving adalimumab, alefacept, efalizumab, etanercept, infliximab, rituximab, ustekinumab, and methotrexate. Based on this analysis, the type of mono-biologic treatment contributes little to the risk of HZ among psoriasis patients. Of note, the negative findings of our study do not mean the unnecessity of vaccination. More efforts must be taken to further determine HZ risk of different therapeutic strategies.
带状疱疹（HZ）已引起公众关注。在免疫功能低下人群中，如使用生物制剂的银屑病患者，HZ的发病率呈上升趋势。仍需要真实世界的证据来调查接受不同生物制剂治疗的患者发生HZ的风险。本研究旨在总结队列研究的结果。在此，我们对队列研究进行了荟萃分析。我们纳入了涉及七种生物制剂（阿达木单抗、阿法西普、依法利珠单抗、依那西普、英夫利昔单抗、利妥昔单抗和乌司奴单抗）以及用于治疗银屑病的甲氨蝶呤的研究。我们使用成对和网络荟萃分析估计HZ的汇总相对风险（RRs）。总体而言，纳入五项研究进行分析。共观察到32827.6患者年。荟萃分析结果显示，在我们的分析中占患者年数最多的阿达木单抗的合并HZ发病率为每1000患者年2.6例。我们基于多个队列的分析表明，接受阿达木单抗、阿法西普、依法利珠单抗、依那西普、英夫利昔单抗、利妥昔单抗、乌司奴单抗和甲氨蝶呤治疗的患者之间无显著差异。基于该分析，单生物制剂治疗类型对银屑病患者发生HZ的风险影响不大。值得注意的是，我们研究的阴性结果并不意味着疫苗接种没有必要。必须做出更多努力来进一步确定不同治疗策略的HZ风险。
