As if the aches and pains of rheumatoid arthritis (RA) weren’t trouble enough, people with this autoimmune disease also develop shingles (herpes zoster) infections more often than the general population. An increasingly popular rheumatoid arthritis treatment – anti-tumor necrosis factor (anti-TNF) medications – had been suspected as a contributing factor to shingles infections, but new research reported this month in the Journal of the American Medical Association found no association between this class of medication and shingles risk.
A research group led by Kevin Winthrop, M.D., from Oregon Health and Sciences University in Portland, enrolled 33,324 anti-TNF users in this study, including patients with rheumatoid arthritis, inflammatory bowel disease, psoriasis, psoriatic arthritis, and ankylosing spondylitis.
The incidence of shingles was compared between this group of anti-TNF users and 25,742 similar patients who were on nonbiologic disease-modifying antirheumatic drugs (DMARDs), such as methotrexate and cyclosporine. Corticosteroid use was controlled for, since high doses of this medication is a known risk factor for shingles.
The risk of shingles was no different between these patient groups; thus, anti-TNF drugs were not associated with an increased risk of this infection. This news should be very reassuring to patients, since shingles is already a significant concern for those with autoimmune diseases. Patients should also keep in mind that the shingles vaccine can be taken prior to starting treatment with anti-TNF medications.
There are five FDA-approved anti-TNF medications:
- Adalimumab (Humira ®)
- Certolizumab (Cimzia ®)
- Etanercept (Enbrel ®)
- Golimumab (Simponi ®)
- Infliximab (Remicade ®)