Risks of herpes zoster in patients with rheumatoid arthritis according to biologic disease-modifying therapy

Huifeng Yun, Fenglong Xie, Elizabeth Delzell, Lang Chen, Emily B. Levitan, James D. Lewis, Kenneth G. Saag, Timothy Beukelman, Kevin Winthrop, John W. Baddley, Jeffrey R. Curtis

Research output: Contribution to journalArticle

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Abstract

Objective To evaluate whether the risks of herpes zoster (HZ) differed by biologic agents with different mechanisms of action (MOAs) in older rheumatoid arthritis (RA) patients. Methods Using Medicare data from 2006-2011, among RA patients with prior biologic agent use and no history of cancer or other autoimmune diseases, this retrospective cohort study identified new treatment episodes of abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab. Followup started on initiation of the new biologic agent and ended at any of the following: first incidence of HZ, a 30-day gap in current exposure, death, a diagnosis of other autoimmune disease or cancer, loss of insurance coverage, or December 31, 2011. We calculated the proportion of RA patients vaccinated for HZ in each calendar year prior to biologic agent initiation and HZ incidence rate for each biologic agent. We compared HZ risks among therapies using Cox regression adjusted for potential confounders. Results Of 29,129 new biologic treatment episodes, 28.7% used abatacept, 15.9% adalimumab, 14.8% rituximab, 12.4% infliximab, 12.2% etanercept, 6.1% tocilizumab, 5.8% certolizumab, and 4.4% golimumab. The proportion of RA patients vaccinated for HZ prior to biologic agent initiation ranged from 0.4% in 2007 to 4.1% in 2011. We identified 423 HZ diagnoses with the highest HZ incidence rate for certolizumab (2.45 per 100 person-years) and the lowest for golimumab (1.61 per 100 person-years). Neither the crude incidence rate nor the adjusted hazard ratio differed significantly among biologic agents. Glucocorticoid use had a significant association with HZ. Conclusion Among older patients with RA, the HZ risk was similar across biologic agents, including those with different MOAs.

Original languageEnglish (US)
Pages (from-to)731-736
Number of pages6
JournalArthritis Care and Research
Volume67
Issue number5
DOIs
StatePublished - May 1 2015

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Herpes Zoster
Biological Factors
Rheumatoid Arthritis
Therapeutics
Incidence
Autoimmune Diseases
Insurance Coverage
Medicare
Glucocorticoids
Neoplasms
Cohort Studies
Retrospective Studies

ASJC Scopus subject areas

  • Rheumatology
  • Medicine(all)

Cite this

Yun, H., Xie, F., Delzell, E., Chen, L., Levitan, E. B., Lewis, J. D., ... Curtis, J. R. (2015). Risks of herpes zoster in patients with rheumatoid arthritis according to biologic disease-modifying therapy. Arthritis Care and Research, 67(5), 731-736. https://doi.org/10.1002/acr.22470

Risks of herpes zoster in patients with rheumatoid arthritis according to biologic disease-modifying therapy. / Yun, Huifeng; Xie, Fenglong; Delzell, Elizabeth; Chen, Lang; Levitan, Emily B.; Lewis, James D.; Saag, Kenneth G.; Beukelman, Timothy; Winthrop, Kevin; Baddley, John W.; Curtis, Jeffrey R.

In: Arthritis Care and Research, Vol. 67, No. 5, 01.05.2015, p. 731-736.

Research output: Contribution to journalArticle

Yun, H, Xie, F, Delzell, E, Chen, L, Levitan, EB, Lewis, JD, Saag, KG, Beukelman, T, Winthrop, K, Baddley, JW & Curtis, JR 2015, 'Risks of herpes zoster in patients with rheumatoid arthritis according to biologic disease-modifying therapy', Arthritis Care and Research, vol. 67, no. 5, pp. 731-736. https://doi.org/10.1002/acr.22470
Yun, Huifeng ; Xie, Fenglong ; Delzell, Elizabeth ; Chen, Lang ; Levitan, Emily B. ; Lewis, James D. ; Saag, Kenneth G. ; Beukelman, Timothy ; Winthrop, Kevin ; Baddley, John W. ; Curtis, Jeffrey R. / Risks of herpes zoster in patients with rheumatoid arthritis according to biologic disease-modifying therapy. In: Arthritis Care and Research. 2015 ; Vol. 67, No. 5. pp. 731-736.
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abstract = "Objective To evaluate whether the risks of herpes zoster (HZ) differed by biologic agents with different mechanisms of action (MOAs) in older rheumatoid arthritis (RA) patients. Methods Using Medicare data from 2006-2011, among RA patients with prior biologic agent use and no history of cancer or other autoimmune diseases, this retrospective cohort study identified new treatment episodes of abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab. Followup started on initiation of the new biologic agent and ended at any of the following: first incidence of HZ, a 30-day gap in current exposure, death, a diagnosis of other autoimmune disease or cancer, loss of insurance coverage, or December 31, 2011. We calculated the proportion of RA patients vaccinated for HZ in each calendar year prior to biologic agent initiation and HZ incidence rate for each biologic agent. We compared HZ risks among therapies using Cox regression adjusted for potential confounders. Results Of 29,129 new biologic treatment episodes, 28.7{\%} used abatacept, 15.9{\%} adalimumab, 14.8{\%} rituximab, 12.4{\%} infliximab, 12.2{\%} etanercept, 6.1{\%} tocilizumab, 5.8{\%} certolizumab, and 4.4{\%} golimumab. The proportion of RA patients vaccinated for HZ prior to biologic agent initiation ranged from 0.4{\%} in 2007 to 4.1{\%} in 2011. We identified 423 HZ diagnoses with the highest HZ incidence rate for certolizumab (2.45 per 100 person-years) and the lowest for golimumab (1.61 per 100 person-years). Neither the crude incidence rate nor the adjusted hazard ratio differed significantly among biologic agents. Glucocorticoid use had a significant association with HZ. Conclusion Among older patients with RA, the HZ risk was similar across biologic agents, including those with different MOAs.",
author = "Huifeng Yun and Fenglong Xie and Elizabeth Delzell and Lang Chen and Levitan, {Emily B.} and Lewis, {James D.} and Saag, {Kenneth G.} and Timothy Beukelman and Kevin Winthrop and Baddley, {John W.} and Curtis, {Jeffrey R.}",
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AU - Yun, Huifeng

AU - Xie, Fenglong

AU - Delzell, Elizabeth

AU - Chen, Lang

AU - Levitan, Emily B.

AU - Lewis, James D.

AU - Saag, Kenneth G.

AU - Beukelman, Timothy

AU - Winthrop, Kevin

AU - Baddley, John W.

AU - Curtis, Jeffrey R.

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N2 - Objective To evaluate whether the risks of herpes zoster (HZ) differed by biologic agents with different mechanisms of action (MOAs) in older rheumatoid arthritis (RA) patients. Methods Using Medicare data from 2006-2011, among RA patients with prior biologic agent use and no history of cancer or other autoimmune diseases, this retrospective cohort study identified new treatment episodes of abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab. Followup started on initiation of the new biologic agent and ended at any of the following: first incidence of HZ, a 30-day gap in current exposure, death, a diagnosis of other autoimmune disease or cancer, loss of insurance coverage, or December 31, 2011. We calculated the proportion of RA patients vaccinated for HZ in each calendar year prior to biologic agent initiation and HZ incidence rate for each biologic agent. We compared HZ risks among therapies using Cox regression adjusted for potential confounders. Results Of 29,129 new biologic treatment episodes, 28.7% used abatacept, 15.9% adalimumab, 14.8% rituximab, 12.4% infliximab, 12.2% etanercept, 6.1% tocilizumab, 5.8% certolizumab, and 4.4% golimumab. The proportion of RA patients vaccinated for HZ prior to biologic agent initiation ranged from 0.4% in 2007 to 4.1% in 2011. We identified 423 HZ diagnoses with the highest HZ incidence rate for certolizumab (2.45 per 100 person-years) and the lowest for golimumab (1.61 per 100 person-years). Neither the crude incidence rate nor the adjusted hazard ratio differed significantly among biologic agents. Glucocorticoid use had a significant association with HZ. Conclusion Among older patients with RA, the HZ risk was similar across biologic agents, including those with different MOAs.

AB - Objective To evaluate whether the risks of herpes zoster (HZ) differed by biologic agents with different mechanisms of action (MOAs) in older rheumatoid arthritis (RA) patients. Methods Using Medicare data from 2006-2011, among RA patients with prior biologic agent use and no history of cancer or other autoimmune diseases, this retrospective cohort study identified new treatment episodes of abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, and tocilizumab. Followup started on initiation of the new biologic agent and ended at any of the following: first incidence of HZ, a 30-day gap in current exposure, death, a diagnosis of other autoimmune disease or cancer, loss of insurance coverage, or December 31, 2011. We calculated the proportion of RA patients vaccinated for HZ in each calendar year prior to biologic agent initiation and HZ incidence rate for each biologic agent. We compared HZ risks among therapies using Cox regression adjusted for potential confounders. Results Of 29,129 new biologic treatment episodes, 28.7% used abatacept, 15.9% adalimumab, 14.8% rituximab, 12.4% infliximab, 12.2% etanercept, 6.1% tocilizumab, 5.8% certolizumab, and 4.4% golimumab. The proportion of RA patients vaccinated for HZ prior to biologic agent initiation ranged from 0.4% in 2007 to 4.1% in 2011. We identified 423 HZ diagnoses with the highest HZ incidence rate for certolizumab (2.45 per 100 person-years) and the lowest for golimumab (1.61 per 100 person-years). Neither the crude incidence rate nor the adjusted hazard ratio differed significantly among biologic agents. Glucocorticoid use had a significant association with HZ. Conclusion Among older patients with RA, the HZ risk was similar across biologic agents, including those with different MOAs.

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