Herpes zoster in patients taking TNFα antagonists for chronic inflammatory joint disease

ObjectiveTo assess the rate of occurrence and outcomes of herpes zoster in patients taking TNFα antagonists.MethodsRetrospective review of the medical records of 300 patients who received TNFα antagonists to treat chronic inflammatory joint disease.ResultsWe identified 9 (9/300, 3%) patients who experienced herpes zoster, 6 women and 3 men, with rheumatoid arthritis (n = 7) or ankylosing spondylitis (n = 2). The drug was infliximab in 4 patients, adalimumab in 2 patients, and etanercept in 3 patients, including 2 patients with a prior history of infliximab therapy (for 12 and 36 months, respectively). Mean treatment duration at the occurrence of herpes zoster was 27 months (range, 6–42 months).DiscussionGlucocorticoid therapy (n = 7) and methotrexate therapy (n = 6) were the only risk factors identified in our study. Mean follow-up was 26 months. All 9 patients achieved a full recovery with antiviral treatment and interruption of the TNFα antagonist. One patient experienced a recurrence after resuming TNFα antagonist therapy.ConclusionThe scant data in the literature suggest a higher risk of herpes zoster with anti-TNFα antibodies than with the soluble receptor. The role for concomitant treatments (glucocorticoids and methotrexate) should be taken into account.