JAMA：抗肿瘤坏死因子治疗未升高带状疱疹风险

美国学者的一项研究表明，在类风湿性关节炎和其他炎性疾病患者中，抗肿瘤换死因子（TNF）新应用者未出现带状疱疹风险升高。论文发表于《美国医学会杂志》[JAMA2013, 309(9):887]。
　　此项研究在风湿性关节炎、炎性肠病以及银屑病、银屑病关节炎或强直性脊柱炎患者中确认了抗TNF新应用者。在各炎性疾病人群中对比抗TNF（33324例）和非生物性缓解病情抗风湿药（DMARD；25742例）新应用者的带状疱疹发病率。对基线糖皮质激素应用进行控制之后，利用Cox回归模型对比带状疱疹的倾向评分校正发病率。主要转归指标为启动抗TNF或非生物性DMARD治疗后带状疱疹发病率。
　　结果显示，在抗TNF治疗新应用者中共确认310例带状疱疹；风湿性关节炎、炎性肠病以及银屑病、银屑病关节炎或强制性脊柱炎组的粗发病率分别为12.1、11.3和4.4/1000患者年。与未应用者相比，在所有疾病中基线应用10 mg及以上糖皮质激素均与带状疱疹风险升高相关（校正危险比[HR] 2.13）。对于风湿性关节炎患者，抗TNF和非生物性DMARD新应用者的带状疱疹校正发病率基本相似（校正HR 1.00）。
与关节炎相关的拓展阅读：

• 补充维生素D 对膝关节骨性关节炎症状无益
• 依那西普维持治疗可控制类风湿关节炎疾病活动
• 银屑病关节炎表现存性别差异
• PNAS：lubricin可能有助于关节炎的治疗
• ARD：银屑病关节炎临床表现存性别差异
• Ann Rheum Dis：日光浴或预防类风湿关节炎
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Association between the initiation of anti-tumor necrosis factor therapy and the risk of herpes zoster.
IMPORTANCE
Herpes zoster reactivation disproportionately affects patients with rheumatoid arthritis (RA). It is unclear whether anti-tumor necrosis factor (anti-TNF) therapy elevates herpes zoster risk.
OBJECTIVES
To ascertain whether initiation of anti-TNF therapy compared with nonbiologic comparators is associated with increased herpes zoster risk.
DESIGN, SETTING, AND PATIENTS
We identified new users of anti-TNF therapy among cohorts of patients with RA, inflammatory bowel disease, and psoriasis, psoriatic arthritis, or ankylosing spondylitis from 1998 through 2007 within a large US multi-institutional collaboration combining data from Kaiser Permanente Northern California, Pharmaceutical Assistance Contract for the Elderly, Tennessee Medicaid, and national Medicaid/Medicare programs. We compared herpes zoster incidence between new anti-TNF users (n=33,324) and patients initiating nonbiologic disease-modifying antirheumatic drugs (DMARDs) (n=25,742) within each inflammatory disease cohort (last participant follow-up December 31, 2007). Within these cohorts, we used Cox regression models to compare propensity score-adjusted herpes zoster incidence between new anti-TNF and nonbiologic DMARD users while controlling for baseline corticosteroid use.
MAIN OUTCOME MEASURES
Incidence of herpes zoster cases occurring after initiation of new anti-TNF or nonbiologic DMARD therapy.
RESULTS
Among 33,324 new users of anti-TNF therapy, we identified 310 herpes zoster cases. Crude incidence rates among anti-TNF users were 12.1 per 1000 patient-years (95% CI, 10.7-13.6) for RA, 11.3 per 1000 patient-years (95% CI, 7.7-16.7) for inflammatory bowel disease, and 4.4 per 1000 patient-years (95% CI, 2.8-7.0) for psoriasis, psoriatic arthritis, or ankylosing spondylitis. Baseline use of corticosteroids of 10 mg/d or greater among all disease indications was associated with elevated risk (adjusted hazard ratio [HR], 2.13 [95% CI, 1.64-2.75]) compared with no baseline use. For patients with RA, adjusted incidence rates were similar between anti-TNF and nonbiologic DMARD initiators (adjusted HR, 1.00 [95% CI, 0.77-1.29]) and comparable between all 3 anti-TNF therapies studied. Across all disease indications, the adjusted HR was 1.09 (95% CI, 0.88-1.36). CONCLUSION AND RELEVANCE: Among patients with RA and other inflammatory diseases, those who initiated anti-TNF therapies were not at higher risk of herpes zoster compared with patients who initiated nonbiologic treatment regimens.