Risk of Herpes Zoster associated with biological therapies for psoriasis and psoriatic arthritis: A systematic review and meta-analysis

Zou, Ailing; Chen, Yongjun; Shi, Ning; Ye, Yu

doi:10.37766/inplasy2021.1.0027

Cited by 1 publication

(5 citation statements)

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“…One systematic review and meta-analysis showed the risk of HZ in psoriasis and psoriatic arthritis patients taking TNF-α inhibitors was higher than that for non-biological systemic therapies. 11 These data appear consistent with the results of this NMA, which suggests that anti-TNF-α treatment, particularly infliximab, may be associated with an increased risk of HZ. However, another recent study reported no significant difference in risk of HZ between patients on anti-TNF-α therapy and those who did not receive systemic medications or phototherapy.…”

Section: Discussionsupporting

confidence: 89%

“…Moreover, our study included combination therapy in the analysis of HZ risk, a topic not addressed by previous meta-analyses. 11,41 Several limitations merit note when interpreting our findings. First, some RCTs were excluded from this NMA due to missing outcome values.…”

Section: Strengths and Limitationsmentioning

confidence: 91%

“…Using NMA in this study enabled us to simultaneously analyze direct and indirect comparisons of multiple treatments across a network of numerous RCTs, cohort studies, and registries to maximize the number of studies and individuals analyzed. Compared to a previous meta-analysis by Zou et al , 11 our study explicitly ranked the relative HZ risk associated with various treatments for psoriatic disease instead of scanning each individual pair-wise comparison, which may be beneficial for clinical physicians in selecting optimal treatment regimens. In 2021, Tang et al 41 used NMA to investigate the risk of HZ among psoriasis patients taking biologics.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Moreover, our study included combination therapy in the analysis of HZ risk, a topic not addressed by previous meta-analyses. 11 , 41 …”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…Some systemic anti-psoriatic agents have been reported to be associated with increased HZ risk in patients with psoriatic disease; however, other studies have reported conflicting results. 8 – 10 One recent systematic review and meta-analysis evaluated the risk of HZ in psoriasis and psoriatic arthritis patients treated with biological therapy; 11 however, whether – and indeed, which – anti-psoriatic agents confer a higher susceptibility to the development of HZ in patients with psoriatic disease is still a matter of debate. Specifically, studies quantifying the comparative risk of HZ among patients receiving interleukin (IL)-17, IL-12/23 and tumor necrosis factor-α (TNF-α) inhibitors, conventional and targeted synthetic DMARDs (tsDMARDs) and combination therapies are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Comparative risk of herpes zoster in patients with psoriatic disease on systemic treatments: a systematic review and network meta-analysis

Chiu

Hung

Huang

et al. 2022

Therapeutic Advances in Chronic Disease

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Background: Numerous previous studies have examined risk of herpes zoster (HZ) in psoriatic disease; however, the results of these studies are conflicting and the relative risks associated with different treatments remain largely unknown. In this meta-analysis, we examined the relative risk of HZ associated with systemic treatments for psoriatic disease. Methods: PubMed, EMBASE, Cochrane Library, and Web of Science databases were searched to identify relevant English-language studies published up to April 2021. Data were extracted using a standardized data extraction form. Network meta-analyses (NMA) was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We examined the differences in HZ risk (incidence rate ratio; IRR) between treatments using a random-effects model for direct pairwise comparisons and NMA. The surface under the cumulative ranking area was calculated to rank the HZ risk for each treatment condition. Results: This study analyzed 13 studies including 19 treatment arms involving a total of 443,104 patients with psoriatic disease. Corticosteroids (CS) [IRR, 2.56; 95% confidence interval (CI), 1.59–4.13], a Janus kinase inhibitor (JAKi; tofacitinib) (IRR, 2.34; 95% CI, 1.03–5.32), infliximab (IRR, 2.32; 95% CI, 1.27–4.21), conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) + CS (IRR, 2.26; 95% CI, 1.23–4.17), anti-tumor necrosis factor-α (anti-TNF-α) + csDMARDs and/or CS (IRR, 2.13; 95% CI, 1.38–3.31), csDMARDs (IRR, 1.62; 95% CI, 1.18–2.22), and anti-TNF-α except infliximab (IRR, 1.61; 95% CI, 1.13–2.30) were all associated with a significantly higher HZ risk compared to controls. CS treatment possessed the highest HZ risk, followed by infliximab and JAKi (tofacitinib). Phosphodiesterase-4 inhibitor, anti-interleukin-17, -23 or -12/23, phototherapy, and acitretin showed a risk similar to controls without significant differences. Conclusion: The NMA demonstrated CS, infliximab, and JAKi (tofacitinib), and several combination treatments were associated with higher HZ risk in patients with psoriasis and psoriatic arthritis. Differences in HZ risk should be taken into consideration when considering optimal psoriasis treatment.

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Section: Discussionsupporting

confidence: 89%

Section: Strengths and Limitationsmentioning

confidence: 91%