Rheumatoid Arthritis Drugs Raise Shingles Risk

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In the latest study, researchers from the German Rheumatism Research Centre in Berlin looked at 5,040 people taking the TNF blockers infliximab (Remicade) or adalimumab (Humira), the fusion protein etanercept (Enbrel) or the monotherapeutic drug anakinra (Kineret).

Although generally considered a TNF blocker, Enbrel was not put in that category for the study because it works with a slightly different mechanism than Remicade and Humira, explained the study's lead author, Dr. Anja Strangfeld, of the epidemiology unit at the research center in Berlin. "The target that is blocked (TNF) is the same, but it is reached with different molecular mechanisms of action," she said.

Of 86 cases of shingles that were reported in 82 participants, 39 were deemed related to treatment with one of the two TNF blockers, and 24 were attributed to treatment with conventional medications.

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People taking Remicade or Humira had almost double the risk of developing shingles, the study found. According to an accompanying editorial, the risk was roughly the same as that seen in general populations over the age of 80. People in the study were, on average, in their early 50s.

Also, according to an accompanying editorial, the cases of shingles observed in the study seemed to be worse than those usually seen in the general population, with 20 percent of episodes categorized as "severe" and 13 percent requiring hospitalization.

The researchers found no statistically significant association between herpes zoster and the other drugs studied or with TNF blockers overall.

"Our recommendations [to physicians and patients] so far are limited," Strangfeld said. "As this is not enough data on the possible benefit of vaccination against shingles in older, immunosuppressed patients with a chronic disease, we are only able to advise a careful monitoring of patients under treatment with TNF blockers for early signs and symptoms of herpes zoster."

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