Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study

Abstract

The incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the “on-treatment” effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio [HR] 4.78, 95% confidence interval [CI] 1.51–15.17), adalimumab (HR 5.52, 95% CI 1.72–17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78–9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60–0.96) and acitretin (HR 0.39, 95% CI 0.24–0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.

Reply to: “Herpes zoster seven days after SARS-CoV-2 vaccination in a patient with ankylosing spondylitis under adalimumab” by Josef Finsterer

“…Furthermore, the patient did not experience any SARS-CoV2 infection, nor any contact with persons known to be infected with SARS-CoV2 or other infective diseases. The only potential risk factor could actually be represented in our patient by the immunosuppressive biological treatment with adalimumab, since anti-TNF inhibitors predispose to a greater risk of HZ (4), as also appropriately highlighted by Professor Finsterer (5,6). However, our patient had been taking adalimumab for 3 years, during which time no HZ event occurred.…”

Bidirectional Association Between Psoriasis and Nonalcoholic Fatty Liver Disease: Real-World Evidence From Two Longitudinal Cohort Studies

“…Similarly, ICD-10-CM codes K75.0 (for NAFLD) and K76 (for NASH) were also applied by population-based studies (52,53). Definitions relating to exposure, outcomes and covariates of diseases applied in this study were based on previous population-based observational studies (4,(22)(23)(24)(54)(55)(56). In addition to applying definition utilized by previous studies, to strengthen the validity of the definition, we also excluded people with less than one impatient or two outpatient records in our study.…”

“…To enhance the validity, only those with more than three outpatient visits based on the diagnosis of the dermatology department were considered to have psoriasis. This definition has been validated in previous studies using NHIRD (23,24). To address potential confounders, variables including age, sex, income level, urbanization status, Charlson comorbidity index (CCI) scores, and comorbidities were considered.…”