Herpes zoster in psoriasis patients treated with tofacitinib

Kevin Winthrop, Mark Lebwohl, Arnon D. Cohen, Jeffrey M. Weinberg, Stephen K. Tyring, Scott T. Rottinghaus, Pankaj Gupta, Kaori Ito, Huaming Tan, Mandeep Kaur, Alexander Egeberg, Lotus Mallbris, Hernan Valdez

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)302-309
Number of pages8
JournalJournal of the American Academy of Dermatology
Volume77
Issue number2
DOIs
StatePublished - Aug 1 2017

Fingerprint

Herpes Zoster
Psoriasis
Varicella Zoster Encephalitis
Placebos
Janus Kinases
tofacitinib
Immunomodulation
Biological Products
Proportional Hazards Models
Vaccination
Incidence

Keywords

  • herpes zoster
  • JAK
  • psoriasis
  • shingles
  • tofacitinib

ASJC Scopus subject areas

  • Dermatology

Cite this

Winthrop, K., Lebwohl, M., Cohen, A. D., Weinberg, J. M., Tyring, S. K., Rottinghaus, S. T., ... Valdez, H. (2017). Herpes zoster in psoriasis patients treated with tofacitinib. Journal of the American Academy of Dermatology, 77(2), 302-309. https://doi.org/10.1016/j.jaad.2017.03.023

Herpes zoster in psoriasis patients treated with tofacitinib. / Winthrop, Kevin; Lebwohl, Mark; Cohen, Arnon D.; Weinberg, Jeffrey M.; Tyring, Stephen K.; Rottinghaus, Scott T.; Gupta, Pankaj; Ito, Kaori; Tan, Huaming; Kaur, Mandeep; Egeberg, Alexander; Mallbris, Lotus; Valdez, Hernan.

In: Journal of the American Academy of Dermatology, Vol. 77, No. 2, 01.08.2017, p. 302-309.

Research output: Contribution to journalArticle

Winthrop, K, Lebwohl, M, Cohen, AD, Weinberg, JM, Tyring, SK, Rottinghaus, ST, Gupta, P, Ito, K, Tan, H, Kaur, M, Egeberg, A, Mallbris, L & Valdez, H 2017, 'Herpes zoster in psoriasis patients treated with tofacitinib', Journal of the American Academy of Dermatology, vol. 77, no. 2, pp. 302-309. https://doi.org/10.1016/j.jaad.2017.03.023
Winthrop, Kevin ; Lebwohl, Mark ; Cohen, Arnon D. ; Weinberg, Jeffrey M. ; Tyring, Stephen K. ; Rottinghaus, Scott T. ; Gupta, Pankaj ; Ito, Kaori ; Tan, Huaming ; Kaur, Mandeep ; Egeberg, Alexander ; Mallbris, Lotus ; Valdez, Hernan. / Herpes zoster in psoriasis patients treated with tofacitinib. In: Journal of the American Academy of Dermatology. 2017 ; Vol. 77, No. 2. pp. 302-309.
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abstract = "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.",
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AU - Winthrop, Kevin

AU - Lebwohl, Mark

AU - Cohen, Arnon D.

AU - Weinberg, Jeffrey M.

AU - Tyring, Stephen K.

AU - Rottinghaus, Scott T.

AU - Gupta, Pankaj

AU - Ito, Kaori

AU - Tan, Huaming

AU - Kaur, Mandeep

AU - Egeberg, Alexander

AU - Mallbris, Lotus

AU - Valdez, Hernan

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N2 - 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.

AB - 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.

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