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

Objective: To assess the rate of occurrence and outcomes of herpes zoster in patients taking TNF alpha antagonists. Methods: Retrospective review of the medical records of 300 patients who received TNF alpha antagonists to treat chronic inflammatory joint disease. Results: We 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). Discussion: Glucocorticoid 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 TNFa antagonist. One patient experienced a recurrence after resuming TNFa antagonist therapy. Conclusion: The scant data in the literature suggest a higher risk of herpes zoster with anti-TNF alpha antibodies than with the soluble receptor. The role for concomitant treatments (glucocorticoids and methotrexate) should be taken into account. (C) 2008 Elsevier Masson SAS. All rights reserved.