Herpes zoster in patients with inflammatory arthritides or ulcerative colitis treated with tofacitinib, baricitinib or upadacitinib: a systematic review of clinical trials and real-world studies
Chrysoula G. Gialouri,Savvina Moustafa,Konstantinos Thomas,Emilia Hadziyannis,Dimitrios Vassilopoulos +4 more
TL;DR: In this article , a systematic review showed higher HZ-risk in RA or UC than PsA patients treated with TOFA, in those treated with higher TOFA doses or with concomitant glucocorticoids.
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Abstract: JAK inhibitors (JAKi) are new targeted-synthetic drugs, approved for various immune-mediated inflammatory diseases (IMIDs), including inflammatory arthritides (rheumatoid arthritis-RA, psoriatic arthritis-PsA, ankylosing spondylitis-AS) and ulcerative colitis (UC). JAKi have been associated with increased risk for herpes zoster (HZ), but the relative risk among different JAKi in these IMIDs remains unclear. We aimed to systematically review the incidence of HZ among RA, PsA, AS and UC patients treated with the approved doses of tofacitinib (TOFA), baricitinib (BARI) or upadacitinib (UPA). PubMed, Embase, Scopus, Cochrane and Web-of-Science were searched up to 30 March 2022. Clinical trials and real-world studies (RWS) were included. Outcomes assessed were the incidence rate (/100 patient-years) or/and cumulative incidence of HZ. From 1710 records, 53 clinical trials and 25 RWS were included (RA: 54, PsA: 8, AS: 4, and UC: 12). In clinical trials, the HZ-incidence was higher in TOFA-treated patients with RA (2.2-7.1/100 patient-years) or UC (1.3-7.6/100 patient-years) compared to PsA (1.7/100 patient-years), and with higher doses of TOFA in UC (10 mg/twice daily: 3.2-7.6/100 patient-years vs. 5 mg/twice daily: 1.3-2.3/100 patient-years). Evidence for HZ-risk in JAKi-treated patients with AS and in UPA-treated patients was limited. The HZ-incidence between TOFA and BARI groups in 2 RA RWS did not differ significantly. Concomitant glucocorticoid, but not methotrexate, use in RA increased the HZ-risk. This systematic review showed higher HZ-risk in RA or UC than PsA patients treated with TOFA, in those treated with higher TOFA doses or with concomitant glucocorticoids. Preventive measures and monitoring of JAKi-treated patients with IMIDs are essential in daily practice.
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Citations
Risk of herpes zoster associated with JAK inhibitors in immune-mediated inflammatory diseases: a systematic review and network meta-analysis
Qingling Xu,Liyuan He,Yufeng Yin +2 more
TL;DR: Some JAK inhibitors, particularly peficitinib, baricit inib, and tofacitinib are associated with a higher risk of herpes zoster infection in patients with IMIDs, according to a network meta-analysis.
25
Refractory alopecia in lupus treated with tofacitinib — a case-based review
TL;DR: A 33-year-old SLE patient with long standing (3 years) refractory alopecia who took tofacitinib and observed a substantial increase in hair growth is reported, sustained at 2-years follow-up even after tapering off glucocorticoids completely.
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Biologics Versus JAK Inhibitors. Part II: Risk of Infections. A Narrative Review
Miguel Mansilla‐Polo,D. Morgado‐Carrasco +1 more
TL;DR: An elevated risk of infections is found, especially with anti-tumor necrosis factor (anti-TNF) agents, rituximab, and JAKi (particularly tofacitinib at high doses), which can increase the risk of infections.
2
Time to talk to adults with rheumatic diseases about herpes zoster vaccination
Mischa Pier,Gertjan L Wolbink,Laura Boekel +2 more
TL;DR: Examination of existing evidence on risk factors for herpes zoster and the safety and efficacy of the recombinant vaccine in patients with rheumatic immune-mediated inflammatory diseases and the necessity of herpes zoster vaccination for these patients discuss the necessity of herpes zoster vaccination for these patients.
1
Editorial: adjuvanted recombinant zoster vaccine in adults with inflammatory bowel disease—time for universal recommendation?
TL;DR: In this paper , a Markov model was constructed to compare the RZV costeffectiveness with no vaccination in Crohn's disease and ulcerative colitis patients under age 60 years, using a simulated cohort of 1 million patients.
1
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