A meta-analysis, published in Medicine (Baltimore), set out to evaluate the risk of herpes zoster (HZ) infections resulting from biological therapies in patients with psoriasis and psoriatic arthritis (PsA). The study, led by Ailing Zou, MD, and colleagues, found that biological therapy treatments, especially tumor necrosis factor-α inhibitors, may increase the risk of HZ in patients with PsA. Younger age and female sex may also be risk factors.
The study authors performed a keyword search of PubMed, Embase, and Web of Science up to October 9, 2020, to identify randomized controlled trials (RCTs) or observational studies of outcomes of biological therapies in patients with PsA compared to non-biological therapies, non-biological systemic therapies, and/or controls, with HZ incidents reported. The Cochrane risk of bias tool and Newcastle-Ottawa scale were used to assess the quality of the RCTs and observational studies, respectively. After assessment, data from nine studies were included for meta-analysis using Stata software (Version 12.0).
After analysis, researchers found that the risk of HZ was higher with biological therapies than with non-biological (odds ratios [OR] = 1.48; 95% confidence interval [CI]:1.18–1.86) and non-biological systemic (OR = 1.32; 95% CI 1.02–1.71; I2 = 0%) therapies. Additionally, the risk of HZ increased significantly with tumor necrosis factor-α inhibitors (OR = 1.50; 95% CI 1.11–2.02).
Of note, the risk of HZ was increased with infliximab (OR = 2.43; 95% CI 1.31–4.50) and etanercept (OR = 1.65; 95% CI: 1.07–2.56), while there was no increased risk associated with adalimumab (OR = 1.21; 95% CI 0.64–2.30), ustekinumab (OR = 2.20; 95% CI 0.89–5.44), alefacept (OR = 1.46; 95% CI 0.20–10.47), and efalizumab (OR = 1.58; 95% CI 0.22–11.34).
The authors acknowledged that the current study was limited by the fact that smaller studies may have been missed in the initial search. Also, because “few RCTs have reported HZ incidents,” most of the included studies were observational.
However, they concluded that biological therapies, particularly infliximab and etanercept, are shown to significantly increase the risk of HZ infection as a result of their immunosuppression.
Source: Medicine (Baltimore)