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Herpes zoster in Tofacitinib: Risk is Further Increased with Glucocorticoids but not Methotrexate

Curtis JR, Xie F, Yang S, Bernatsky S, Chen L, Yun H, Winthrop K. - Arthritis Care Res 2018 DOI 10.1002/acr.23769

The rate of Herpes Zoster (HZ) in tofacitinib (TOF) users with concomitant glucocorticoids (GC) was approximately double that of other TOF combination therapies.
TOF is an effective treatment for RA. Increased HZ risk has been observed with the use of JAK inhibitors, whereas the HZ risk with biologics and targeted RA therapies are comparable. This study evaluated the HZ risk in TOF users according to concomitant GC, MTX, both, or neither.
MarketScan and Medicare data were used to identify 8030 rheumatologist-diagnosed RA patients initiating TOF for the first time. Cox regression was used to calculate hazard ratios for HZ risk in TOF users, with and without concomitant MTX and GC.
Analyses revealed a two-fold increase in HZ infection when GCs were used (either with or without MTX). The addition of MTX conferred no additional risk. Younger age, male sex, and vaccination with the live virus zoster vaccine were associated with a lower risk for HZ.
In conclusion, in TOF users, HZ occurred at a rate of 3-4 per 100 patient-years and was approximately doubled by GC exposure.

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Upload date: November 2018

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