Ann Rheum Dis：抗肿瘤坏死因子治疗或可增加带状疱疹发病风险

一项英国风湿病学会生物制剂注册（BSRBR）研究显示，抗肿瘤坏死因子（TNF）治疗可显著升高类风湿关节炎（RA）患者带状疱疹的发病风险。论文发表于《风湿病年鉴》（Ann Rheum Dis 2013，72：229）杂志。
　　该研究共分析了11881例接受抗TNF治疗及3673例接受非生物性缓解病情抗风湿病药（nbDMARD）治疗患者，每6个月对患者及医师进行问卷调查随访。
　　结果，抗TNF组及nbDMARD组患者皮肤及软组织感染（SSSI）粗发病率分别为1.6例/（百人·年）及0.7例/（百人·年），校正风险比（HR）为1.4；带状疱疹为1.6例/（百人·年）及0.8例/（百人·年），校正HR为1.8。
　　不同抗TNF药物间两组SSSI发病率无显著差异。接受阿达木单抗治疗患者发生带状疱疹风险最低，而接受英夫利昔单抗治疗者风险最高。但研究者也提示，由于可能存在残余混杂，尚不能肯定抗TNF治疗与带状疱疹发病率升高间存在因果关系。
与风湿病相关的拓展阅读： 

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Risk of skin and soft tissue infections (including shingles) in patients exposed to anti-tumour necrosis factor therapy: results from the British Society for Rheumatology Biologics Register
Introduction
Anti-tumour necrosis factor (TNF) therapy is a mainstay of treatment in rheumatoid arthritis (RA). In 2001, BSRBR was established to evaluate the safety of these agents. This paper addresses the safety of anti-TNF therapy in RA with specific reference to serious skin and soft tissue infections (SSSI) and shingles.
Methods
A cohort of anti-TNF-treated patients was recruited alongside a comparator group with active RA treated with non-biological disease-modifying antirheumatic drugs (nbDMARD). 11 881 anti-TNF and 3673 nbDMARD patients were analysed. Follow-up was by 6-monthly questionnaires to patients and clinicians. Analyses considered SSSI and shingles separately. Incidence rates (IR) were calculated and then compared using survival analyses.
Results
The crude IR for SSSI were: anti-TNF 1.6/100 patient-years (95% CI 1.4 to 1.8); nbDMARD 0.7/100 patient-years (95% CI 0.5 to 1.0) and shingles: anti-TNF 1.6/100 patient-years (95% CI 1.3 to 2.0); nbDMARD 0.8/100 patient-years (95% CI 0.6 to 1.1). Adjusted HR were SSSI 1.4 (95% CI 0.9 to 2.4), shingles 1.8 (95% CI 1.2 to 2.8). For SSSI, no significant differences were seen between anti-TNF agents. For shingles, the lowest risk was observed for adalimumab (adjusted HR vs nbDMARD) 1.5 (95% CI 1.1 to 2.0) and highest for infliximab (HR 2.2; 95% CI 1.4 to 3.4)).
Conclusion
A significantly increased risk of shingles was observed in the anti-TNF-treated cohort. The risk of SSSI tended towards being greater with anti-TNF treatment but was not statistically significant. As with any observational dataset cause and effect cannot be established with certainty as residual confounding may remain. This finding would support the evaluation of zoster vaccination in this population.