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Possible Risk of Herpes Zoster with Anti-TNF-α Therapy

Biologic agents targeting tumor necrosis factor associated with increased risk of herpes zoster

TUESDAY, Feb. 17 (HealthDay News) -- Monoclonal antibodies directed against tumor necrosis factor-alpha (TNF-α), a class of drugs that treat a variety of systemic inflammatory diseases, are associated with an increased risk of herpes zoster, according to research published in the Feb. 18 issue of the Journal of the American Medical Association.

Anja Strangfeld, M.D., of the German Rheumatism Research Center in Berlin, Germany, and colleagues analyzed data from RABBIT, an ongoing nationwide prospective cohort study initiated in 2001 to determine the efficacy and safety of anti-TNF-α agents to treat rheumatoid arthritis. The study included 5,040 patients who received treatment with either anti-TNF-α monoclonal antibodies, the TNF-α-targeting fusion protein etanercept, or conventional disease-modifying antirheumatic drugs (conventional DMARDs).

A total of 86 episodes of herpes zoster were reported among 82 patients during the 2001-2006 study period, the investigators found. Incidence rates of 11.1, 8.9 and 5.6 per 1000 patient-years were reported for monoclonal antibodies, etanercept and conventional DMARDs, respectively. When adjusted for age, glucocorticoid use and disease severity, the increase in herpes zoster incidence associated with monoclonal antibodies was statistically significant; non-significant associations were reported for etanercept or conventional DMARDs, the researchers report.

"TNF-α inhibitors have revolutionized the management of a number of difficult diseases, especially inflammatory arthritis, but clinicians must continue to remain aware of the potential for serious infectious complications, which now include herpes zoster," the authors of an accompanying editorial write.

The study authors report funding and support by grants from the pharmaceutical industry.

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