Ustekinumab increases risk of herpes zoster in patients with spondyloarthritis

Abstract

Objective: To report the risk factors of herpes zoster (HZ) in patients with spondyloarthritis (SpA). Method: Three hundred and forty four patients with an expert diagnosis of SpA were identified retrospectively from 3 rheumatology centers in Hong Kong. Medical records from 1998 to 2018 were reviewed for incidence of HZ and demographic parameters. This included age, sex, duration of follow‐up, co‐morbidities, and smoking and drinking status. We identified all disease modifying anti‐rheumatic drugs (DMARDs) used, including sulphasalazine, methotrexate, leflunomide, cyclosporin, steroids, etanercept, infliximab, adalimumab, golimumab, secukinumab and ustekinumab. Cox regression models were used to evaluate hazard ratios (HRs) of HZ in SpA patients on different immunosuppressants. Result: Among 344 patients with SpA, the male‐to‐female ratio was 6.1:3.9. Mean age was 47.6 years. Mean disease duration was 8.2 years. Sixty‐nine patients were diagnosed with psoriatic arthritis (PsA). Sixteen patients suffered from HZ during the period of study. The incident was 5.68 per 1000 patient‐years. Univariate cox regression showed sulphalazine (HR 0.31, P = 0.07), ustekinumab (HR 11.20, P = 0.03), diabetes (HR 4.11, P = 0.01), renal impairment (HR 4.30, P = 0.01) and thyroid disease (HR 5.67, P = 0.02) were associated with HZ. Multivariate cox regression model showed an increased risk of HZ with use of ustekinumab (HR 14.46, 95% CI 1.65; 126.49, P = 0.02), renal impairment (HR 3.35. 95% CI 0.97; 11.54, P = 0.06) and thyroid disease (HR 6.83, 95% CI 1.47; 31.71, P = 0.01). Conclusion: Use of ustekinumab was associated with HZ in patients with SpA. Other identified risks factors were renal impairment and thyroid disease.