SEOUL, SOUTH KOREA – Treatment of psoriasis patients with biologic agents isn’t associated with increased risk of herpes zoster, according to a large population-based Israeli study.
In contrast, the use of methotrexate, cyclosporine, acitretin, and systemic corticosteroids is associated with an increased risk of herpes zoster in psoriasis patients, Dr. Arnon D. Cohen said at the World Congress of Dermatology.
Dr. Arnon D. Cohen
He reported on 22,330 psoriasis patients followed over 10 years at Clalit Health Services, Israel’s largest HMO. This was a real-world patient population, 53% of whom were female, in contrast to the highly selected populations in randomized clinical trials, which are typically 65%-69% male.
During nearly 220,000 person-years of follow-up there were 1,321 cases of herpes zoster. The baseline rate during periods when patients weren’t on any form of systemic therapy was 4.6 cases/1,000 patient-years. In contrast, the rate during cyclosporine therapy was more than 10-fold higher at 48.4 cases/1,000 patient-years.
Eighteen percent of psoriasis patients were on systemic corticosteroids at some point during the study period; that medication was associated with a herpes zoster rate of 25.7/1,000 patient-years of exposure. Other therapies that conferred significantly increased risk were methotrexate at 17 cases/1,000 patient-years and acitretin (Soriatane) at 5.4 cases/1,000 patient-years, reported Dr. Cohen, director of the department of quality measures at Clalit and a dermatologist at Ben-Gurion University of the Negev, Beer-Sheva, Israel.
In contrast, no cases of herpes zoster occurred in psoriasis patients on alefacept (Amevive), efalizumab (Raptiva) or adalimumab (Humira). Nor was the incidence increased beyond baseline in patients on PUVA, UVB, or etanercept (Enbrel).
In a Cox logistic regression analysis, systemic corticosteroid therapy was associated with a 2.4-fold increased risk of developing herpes zoster. Being female was associated with a significant 16% increase in risk. Infliximab (Remicade) therapy was associated with a 1.8-fold increase in risk, a trend that did not achieve statistical significance (P =.09).
Dr. Cohen and his coinvestigators conducted this study because, even though the biologic agents are recognized as conferring increased risk of tuberculosis and serious bacterial infections, very little is known about their association, if any, with viral infections.
Dr. Cohen declared having no relevant financial interests.