Navigation Links
Rheumatoid Arthritis Drugs Raise Shingles Risk
Date:2/17/2009

Older people and those also taking steroids are most vulnerable, study finds

TUESDAY, Feb. 17 (HealthDay News) -- A class of medications used widely to treat rheumatoid arthritis and other autoimmune diseases might increase the risk of shingles, especially among older people and those who are also taking steroids.

But while the findings, appearing in the Feb. 18 issue of the Journal of the American Medical Association, might raise awareness of the potential complication among physicians and patients, some experts say it's unlikely to change how the drugs are used.

"We've changed people's lives with use of these anti-tumor necrosis factor drugs. People who were housebound are now leading relatively normal lives," said Dr. Guy Fiocco, an assistant professor of internal medicine at Texas A&M Health Science Center College of Medicine and director of rheumatology at Scott & White in Temple. "This modest increase in risk is not going to stop us prescribing the drug. It may make us more aware."

The increased risk did not reach clinical significance, and, Fiocco added, rheumatoid arthritis itself probably increases the risk of shingles (herpes zoster), as do steroids, which are taken by many people with the disease.

Although the link between TNF blockers and fungal and bacterial infections is fairly well-established, associations with viral infections are less clear.

There have, however, been reports of severe herpes zoster in people taking TNF blockers.

TNF blockers, which suppress the immune system, are used for a variety of autoimmune disorders, including Crohn's disease and psoriasis. In September, the U.S. Food and Drug Administration asked the manufacturers of Humira, Cimzia, Enbrel and Remicade to bolster safety warnings on the risk of developing opportunistic fungal infections. The drugs already carried black-box warnings related to different safety issues. This followed an announcement by the FDA that it would begin a safety review of the drugs, spurred by concerns that the drugs might be associated with cancer.

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.

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."

A vaccine against shingles is available and recommended for people age 60 and over, but it has not been studied in those with rheumatoid arthritis or people taking TNF blockers, the editorial indicated.

And, Fiocco pointed out, choosing a rheumatoid arthritis drug can be complicated. Given that people on Enbrel had a lower risk of developing herpes zoster than those on TNF blockers, for instance, that agent might seem to be the drug of choice for some physicians and patients.

But, he said, Medicare covers Remicade better than Enbrel and other injectable drugs.

"It's not always science that drives this," Fiocco said. "There are different finances and patient preferences. There's a lot that goes into making a decision."

More information

The National Institute of Neurological Disorders and Stroke has more on shingles.



SOURCES: Guy Fiocco, M.D., assistant professor, internal medicine, Texas A&M Health Science Center College of Medicine, and director, rheumatology, Scott & White, Temple, Texas; Anja Strangfeld, M.D., epidemiology unit, German Rheumatism Research Centre, Berlin; Feb. 18, 2009, Journal of the American Medical Association


'/>"/>
Copyright©2009 ScoutNews,LLC.
All rights reserved  

Related medicine news :

1. Gene Therapy May Ease Rheumatoid Arthritis
2. Process found to play role in rheumatoid arthritis could lead to new treatment
3. Current and Emerging Therapies Have No Advantage Over Enbrel in Reducing the Signs and Symptoms of Rheumatoid Arthritis
4. Rheumatoid Arthritis Hits Women Harder
5. Growth Opportunities for Actemra Will Propel Roche to Sixth Position in the Rheumatoid Arthritis Market by 2012
6. CEL-SCI Launches Study to Determine Long Lasting Beneficial Effects of its Rheumatoid Arthritis Vaccine
7. Medicaid policies vary widely for rheumatoid arthritis drugs
8. Wide variability in rheumatoid arthritis drug suggests alternative dosing should be considered
9. Biologics Dont Raise Cancer Risk in Rheumatoid Arthritis Patients
10. Rheumatoid Arthritis May Harm Gums
11. New Study Highlights Need for Better Interaction and Education Between Rheumatoid Arthritis Patients and Care Providers
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Rheumatoid Arthritis Drugs Raise Shingles Risk
(Date:2/9/2016)... Fort Worth, Texas (PRWEB) , ... February 09, ... ... restoration and reconstruction firm helping businesses recover after a disaster, announced today the ... restoration service companies in Hawaii. , “Investing in like-minded companies who ...
(Date:2/9/2016)... Charlotte, NC (PRWEB) , ... February 09, 2016 ... ... support the launch and production of its newest mobility device, the StandUp Walker. ... innovations in walker design in the last 50 years. , StandUp Walker’s novel ...
(Date:2/9/2016)... ... February 09, 2016 , ... Cirracore Enterprise Cloud, today ... workloads to the cloud. Cirracore provides a secure VMware® vCloud Air based ... Internet. Transformation Solutions (TSL Partners) provides a full range of services from ...
(Date:2/9/2016)... FL (PRWEB) , ... February 09, 2016 , ... ... innovative specialty pharmacies, announces today the continuation of the ‘Pay It Forward’ program ... each prescription referral received at our specialty pharmacy. , “Since our Pay ...
(Date:2/9/2016)... ... February 09, 2016 , ... On January 12, 2016 Paul McElwee, ... after they noticed their furnace not producing any heat. Shortly after entering the home, ... heat exchanger was leaking dangerous levels of carbon monoxide into the home, at 2,000 ...
Breaking Medicine News(10 mins):
(Date:2/9/2016)... 9, 2016 QGEN ... den Abschluss eines Kooperationsvertrags mit 10x Genomics ... in den Bereichen Next-Generation-Sequencing (NGS), Single-Cell-Biology und ... Frankfurt Prime Standard: QIA) gab heute den ... die Entwicklung und Förderung umfassender Lösungen in ...
(Date:2/9/2016)... 2016   AllCare Plus Pharmacy announced today ... of Approval ® for Home Care Accreditation ... The Gold Seal of Approval ® is a ... providing safe and effective care.  ... a rigorous on-site survey in January 2016. The survey ...
(Date:2/9/2016)... 9, 2016 The leader in accelerated orthodontics, ... is the recipient of the 2015 Townie Choice ... Class II medical device that speeds up orthodontic tooth ... pain often associated with treatment, AcceleDent was selected by ... annual Orthotown survey of the most reliable ...
Breaking Medicine Technology: