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No link between TNF antagonists and herpes zoster

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1432 (Published 06 March 2013) Cite this as: BMJ 2013;346:f1432

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Biologically active treatments are probably not to blame for high rates of herpes zoster virus in adults with rheumatioid arthritis, say researchers. They found no association between these agents and risk of shingles in a series of sophisticated analyses that compared adults starting treatment with tumour necrosis factor (TNF) antagonists with similar adults starting treatment with other disease modifying drugs.

The researchers examined cohorts with rheumatoid arthritis, inflammatory bowel disease, psoriasis, and ankylosing spondylitis from four large US databases.

TNF antagonists did not seem to increase the risk of shingles in any single cohort, or in all cohorts combined (n=59 066), relative to non-biological treatments. Final comparisons were extensively adjusted using a propensity score.

Crude incidence of shingles was highest in adults with rheumatoid arthritis (12.1 per 1000 person years in those using TNF antagonists; 12.7 per 1000 person years in those taking other drugs; adjusted hazard ratio 1.00, 95% CI 0.77 to 1.29). We should look carefully at the possibility of vaccination, say the researchers.

Notes

Cite this as: BMJ 2013;346:f1432