Herpes Zoster Reactivation in Patients With Rheumatoid Arthritis: Analysis of Disease Characteristics and Disease-Modifying Antirheumatic Drugs
Herpes Zoster Reactivation in Patients With Rheumatoid Arthritis: Analysis of Disease Characteristics and Disease-Modifying Antirheumatic Drugs
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DOI：
10.1002/acr.22628
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发表时间：
2015-12-01
影响因子：
4.7
通讯作者：
Curtis, Jeffrey R.
中科院分区：
文献类型：
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作者：
Pappas, Dimitrios A.;Hooper, Michele M.;Curtis, Jeffrey R.
目标。在CORRONA登记的类风湿关节炎(RA)患者中，确定与带状疱疹(HZ)风险增加相关的类风湿关节炎(RA)特征，并评估肿瘤坏死因子抑制剂(TNFi)或非TNFi生物制剂的启动者或(在那些目前正在服用或以前曾接受甲氨蝶呤[MTX]治疗的患者中)除MTX之外的常规合成抗风湿药物(CsDMARDS)的风险。COX回归模型估计了首次HZ发病率和选定的RA特征之间的关联，包括疾病活动性。目前或过去服用MTX(排除较轻的RA疾病)的RA患者HZ的药物相关风险根据治疗开始(TNFi与非TNFi与csDMARD)进行分类。风险比(HRs)估计每一治疗开始类别的HZ风险，在调整倾向评分(PS)五分位数分层以控制潜在混杂因素后。共有28852名患者贡献了95287人年。729例观察到的HZ病例每千人年粗发病率为7.7%(95%可信区间[95%可信区间]7.1-8.2%)，低于以前的RA队列。然而，与以前的研究一致，年龄增加(HR 1.14，95%CI为1.09-1.19每5年)和强的松治疗=7.5 mg/天(HR 1.81，95%CI 1.23-2.67)与HZ的风险增加相关。对于TNFi暴露，PS分层分析显示csDMARDS的HR为1.36(95%可信区间0.82~2.25)，非TNFi暴露的HR为0.83(95%可信区间0.51~1.38)。在CORRONA登记中，以前或现在服用MTX的RA患者的HZ风险随着年龄的增加和泼尼松剂量的增加而增加。在这些类风湿性关节炎患者中，接受TNFi治疗后的HZ风险与非TNFI患者与csDMARDS患者相比具有可比性。
Objective. To identify the rheumatoid arthritis (RA) characteristics associated with increased herpes zoster (HZ) risk in the Corrona registry RA patients, and to evaluate the risk in initiators of tumor necrosis factor inhibitors (TNFi) or non-TNFi biologic agents or (among those who were currently on or had been previously treated with methotrexate [MTX]) conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) other than MTX.Methods. Cox regression modeling estimated the association between first HZ incidence and selected RA characteristics, including disease activity. Medication-related risk for HZ in RA patients taking current or past MTX (to exclude milder RA disease) were categorized by treatment initiation (TNFi versus non-TNFi versus csDMARD). Hazard ratios (HRs) estimated HZ risk of each treatment initiation category after stratification on trimmed propensity score (PS) quintiles to control for potential confounders.Results. A total of 28,852 patients contributed 95,287 person-years. Seven hundred twenty-nine observed HZ cases yielded a 7.7 (95% confidence interval [95% CI] 7.1-8.2) per 1,000 patient-years crude incidence rate, lower than found in prior RA cohorts. However, consistent with prior studies, increasing age (HR 1.14, 95% CI 1.09-1.19 per 5 years) and prednisone therapy >= 7.5 mg/day (HR 1.81, 95% CI 1.23-2.67) were associated with a higher HZ risk. Referent to TNFi exposure, PS-stratified analysis showed an HR for csDMARDs of 1.36 (95% CI 0.82-2.25) and for non-TNFi of 0.83 (95% CI 0.51-1.38).Conclusion. In the Corrona registry, the HZ risk in RA patients taking prior or current MTX increased with older age and higher prednisone dose. The HZ risk among these patients with RA was comparable after initiation of TNFi versus non-TNFi versus csDMARDs.