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."
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
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