Herpes zoster in psoriasis patients treated with tofacitinib - 14/12/17
, Mark Lebwohl, MD b, Arnon D. Cohen, MD, PhD c, d, Jeffrey M. Weinberg, MD b, Stephen K. Tyring, MD, PhD e, Scott T. Rottinghaus, MD f, Pankaj Gupta, PhD f, Kaori Ito, PhD f, Huaming Tan, PhD f, Mandeep Kaur, MD, MS g, Alexander Egeberg, MD, PhD h, Lotus Mallbris, MD, PhD g, Hernan Valdez, MD iAbstract |
Background |
Tofacitinib is an oral Janus kinase (JAK) inhibitor. Immunomodulatory therapies can increase the risk for herpes zoster (HZ) in patients with psoriasis.
Objective |
To evaluate the relationship between tofacitinib use and HZ risk.
Methods |
We used phases 2 and 3 and long-term extension (LTE) data from the tofacitinib development program in psoriasis to calculate HZ incidence rates (IR; events per 100 patient-years); potential HZ risk factors were evaluated using Cox-proportional hazard models.
Results |
One hundred thirty (3.6%) patients on tofacitinib (IR 2.55), no patients on placebo, and 2 using etanercept (IR 2.68) developed HZ. Nine patients (7%) were hospitalized, and 8 (6%) had multidermatomal HZ; no encephalitis, visceral involvement, or deaths occurred. In total, 121 (93%) patients on tofacitinib continued or resumed use after HZ. HZ risk factors included Asian descent (hazard ratio [HR] 2.92), using tofacitinib 10 mg twice daily (vs 5 mg twice daily; HR 1.72), prior use of biologics (HR 1.72), and older age (HR 1.30).
Limitations |
Generalizability to other psoriasis populations might be limited. The effect of HZ vaccination was not studied.
Conclusion |
Tofacitinib is associated with increased HZ risk relative to placebo. Asian race, increasing age, higher dose, and prior biologic exposure are associated with heightened risk.
Le texte complet de cet article est disponible en PDF.Key words : herpes zoster, JAK, psoriasis, shingles, tofacitinib
Abbreviations used : AE, CI, HZ, IR, JAK, LTE, PASI, PY, RA, VZV
Plan
| Funding sources: Supported by Pfizer Inc. |
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| Conflicts of interest: Dr Winthrop has received research funds from Pfizer and BMS. He has received consultant honoraria from Pfizer, UCB, BMS, Lilly, AbbVie, and Galapagos. Dr Lebwohl is an employee of Mount Sinai, which receives research funds from Amgen, Anacor, Boehringer Ingleheim, Celgene, Lilly, Janssen Biotech, Kadmon, LEO Pharmaceuticals, Medimmune, Novartis, Pfizer, Sun Pharmaceuticals, and Valeant. Dr Cohen has been an advisor, consultant, investigator, or speaker for Abbvie, Boehringer, Ingelheim, Dexcel Pharma, Janssen, Neopharm, Novartis, Perrigo, Pfizer, and Rafa. Dr Weinberg has received honoraria from Pfizer. Dr Tyring has received research grants from Pfizer. Drs Rottinghaus, Egeberg, and Mallbris were employees of Pfizer Inc at the time of the analysis. Drs Gupta, Ito, Tan, Kaur, and Valdez are employees and shareholders of Pfizer Inc. |
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| Reprints not available from the authors. |
Vol 77 - N° 2
P. 302-309 - août 2017 Retour au numéro
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