Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study

Abstract The incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zost...

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Main Authors: Sze-Wen Ting, Sze-Ya Ting, Yu-Sheng Lin, Ming-Shyan Lin, George Kuo
Format: Article
Language:English
Published: Nature Publishing Group 2021-06-01
Series:Scientific Reports
Online Access:https://doi.org/10.1038/s41598-021-91356-3
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spelling doaj-2cf49c3f558e48b2a34124e96af85b9d2021-06-06T11:38:55ZengNature Publishing GroupScientific Reports2045-23222021-06-011111810.1038/s41598-021-91356-3Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort studySze-Wen Ting0Sze-Ya Ting1Yu-Sheng Lin2Ming-Shyan Lin3George Kuo4Department of Dermatology, New Taipei City Tu-Cheng Municipal HospitalDepartment of Pediatric Surgery, Linkou Chang Gung Memorial HospitalDepartment of Cardiology, Chiayi Chang Gung Memorial HospitalDepartment of Cardiology, Chiayi Chang Gung Memorial HospitalDepartment of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial HospitalAbstract The incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the “on-treatment” effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio [HR] 4.78, 95% confidence interval [CI] 1.51–15.17), adalimumab (HR 5.52, 95% CI 1.72–17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78–9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60–0.96) and acitretin (HR 0.39, 95% CI 0.24–0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.https://doi.org/10.1038/s41598-021-91356-3
collection DOAJ
language English
format Article
sources DOAJ
author Sze-Wen Ting
Sze-Ya Ting
Yu-Sheng Lin
Ming-Shyan Lin
George Kuo
spellingShingle Sze-Wen Ting
Sze-Ya Ting
Yu-Sheng Lin
Ming-Shyan Lin
George Kuo
Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study
Scientific Reports
author_facet Sze-Wen Ting
Sze-Ya Ting
Yu-Sheng Lin
Ming-Shyan Lin
George Kuo
author_sort Sze-Wen Ting
title Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study
title_short Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study
title_full Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study
title_fullStr Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study
title_full_unstemmed Risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study
title_sort risk of herpes zoster in psoriasis patients receiving systemic therapies: a nationwide population-based cohort study
publisher Nature Publishing Group
series Scientific Reports
issn 2045-2322
publishDate 2021-06-01
description Abstract The incidence of herpes zoster in psoriasis patients is higher than in the general population. However, the association between herpes zoster risk and different systemic therapies, especially biologic agents, remains controversial. This study investigated the association between herpes zoster risk and several systemic antipsoriasis therapies. This prospective open cohort study was conducted using retrospectively collected data from the Taiwan National Health Insurance Research Database. We included 92,374 patients with newly diagnosed psoriasis between January 1, 2001, and December 31, 2013. The exposure of interest was the “on-treatment” effect of systemic antipsoriasis therapies documented by each person-quarter. The outcome was the occurrence of newly diagnosed herpes zoster. During a mean follow-up of 6.8 years, 4834 (5.2%) patients were diagnosed with herpes zoster after the index date. Among the systemic antipsoriasis therapies, etanercept (hazard ratio [HR] 4.78, 95% confidence interval [CI] 1.51–15.17), adalimumab (HR 5.52, 95% CI 1.72–17.71), and methotrexate plus azathioprine (HR 4.17, 95% CI 1.78–9.82) were significantly associated with an increased risk of herpes zoster. By contrast, phototherapy (HR 0.76, 95% CI 0.60–0.96) and acitretin (HR 0.39, 95% CI 0.24–0.64) were associated with a reduced risk of herpes zoster. Overall, this study identified an association of both etanercept and adalimumab with an increased risk of herpes zoster among psoriasis patients. Acitretin and phototherapy were associated with a reduced risk.
url https://doi.org/10.1038/s41598-021-91356-3
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