Study: Little difference in shingles risk among RA biologics

Results of a new study suggest that no matter what biologic they are treated with, older patients with rheumatoid arthritis (RA) face pretty much the same risk of developing herpes zoster.

Jeffrey R. Curtis, M.D., of the University of Alabama at Birmingham, and colleagues set out to determine whether the risk of shingles in older patients with RA differs depending on which biologic drug is being used. Using 2006-2011 Medicare data on RA patients with prior biologic use and no history of cancer or other autoimmune diseases, the retrospective cohort study identified new treatment episodes of abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab and tocilizumab.

The researchers calculated the proportion of RA patients vaccinated for shingles in each calendar year prior to biologic initiation as well as the incidence rate of shingles for each biologic. They then compared risks among therapies using Cox regression adjusted for potential confounders.

After adjusting for age, sex, race, comorbidities and use of other medications, the researchers found there were no significant differences in hazard ratios for any of the biologics compared with the referent, abatacept (Orencia, Bristol-Myers Squibb).

The study found that in contrast, patients who used glucocorticoids had significantly higher risks. For those on doses above 7.5 mg per day, the hazard ratio was 2.35; for those on lower doses, it was 1.55.

“Oral steroids like prednisone significantly increased the risk for herpes zoster,” Dr. Curtis tells Dermatology Times. “Steroids were more risky than any of the biologics that were studied, which in general had comparable risks for zoster to each another.”

As for the effect of shingles vaccinations, there was both good and bad news. The good news is that patients who had gotten the shingles vaccine before initiating a biologic were found to have lower risks. The bad news? Rates of vaccination were very low: 0.4 percent in 2007 and 4.1 percent in 2011.

The low rates “indicate a compelling need for vaccination for RA patients (and) a need for greater awareness among rheumatologists to provide this important preventive health service,” the study authors wrote.

The study was published online Sept. 8 in Arthritis Care and Research.

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