A retrospective study from the Taiwan National Health Insurance Research Database of 92,374 patients with psoriasis indicates that those treated with biologics have a higher risk of developing herpes zoster. Acitretin and phototherapy were associated with a reduced risk of herpes zoster.
The study was published in Scientific Reports (June 3, 2021).
The authors of the study note that the incidence of herpes zoster in people with psoriasis is higher than in the general population. The biologics included in the study (etanercept, adalimumab and methotrexate plus azathioprine) appear to increase the incidence. Ustekinumab was also investigated and no cases of herpes zoster were linked to this therapy, but ustekinumab was not approved until 2011 in Taiwan.
In the study, the researchers included patients with newly diagnosed psoriasis from Jan. 1, 2001, to Dec. 31, 2013. During a mean follow-up period of 6.8 years, 4,834 (5.2%) patients were diagnosed with herpes zoster. 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. Interestingly, 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.
The researchers noted that concurrent exposure to steroids and statins were also linked to a higher risk of herpes zoster, as were older age, female sex, hypertension, dyslipidemia, psoriatic arthritis and a high Charleston comorbidity index score.
They concluded clinicians should consider this risk and potential ways to mitigate it while continuing to treat their psoriasis patients with the most effective therapy.