The combination of methotrexate and biologics for the treatment of psoriasis may increase the risk of herpes zoster infection, according to a large, database cohort study published in JAMA Dermatology.
Analysis of medical records for 95,941 patients with psoriasis showed treatment with both biologic medications and methotrexate was associated with a significant 66% increase in the incidence of herpes zoster, compared with a control group, during more than 11 years of follow-up. Episodes of herpes zoster (HZ) occurring in a patient following at least 6 consecutive treatment-free months or in a patient who did not receive any of the listed medications at any time during follow-up were counted as HZ episodes in the control group. The multivariate regression analysis was adjusted for age, sex, psoriasis severity, Charlson comorbidity index, steroid administration per year, and socioeconomic status.
The study found phototherapy, methotrexate alone, cyclosporine, or biologic medications as single agents did not significantly increase the risk, while acitretin therapy was associated with a significant 31% decrease in the incidence of herpes zoster (JAMA Dermatol. 2015 March 22 [doi:10.1001/jamadermatol.2014.4956]).
“Our study results might suggest the need for prophylactic vaccination against VZV [varicella zoster virus] in patients with psoriasis and multiple risk factors for HZ (eg, age, female sex) as part of the preparation for biologic medication treatments in the appropriate clinical setting,” wrote Dr. Guy Shalom of Soroka Medical Center, Beer-Sheva, Israel, and his coauthors.
One author reported consultancies and research grants from a range of pharmaceutical companies. There were no other disclosures.