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Ustekinumab and herpes zoster
1Department of Dermatology, CHU du Sart Tilman, University of Liège, Liège, Belgium.
Dermatology (Basel, Switzerland)
|January 27, 2011
Summary
Ustekinumab treatment for psoriasis may increase the risk of severe herpes zoster (HZ). Consider HZ vaccination before starting ustekinumab to mitigate this risk.
Area of Science:
- Immunology
- Dermatology
- Virology
Background:
- Tumor necrosis factor-alpha (TNF-α) antagonists are associated with increased risk of herpes zoster (HZ).
- Ustekinumab, a monoclonal antibody targeting IL-12 and IL-23, is used for moderate-to-severe plaque psoriasis.
- Limited data exists on HZ occurrence with ustekinumab, with only common HZ reported in clinical trials.
Observation:
- Two patients with severe psoriasis developed severe, multidermatomal HZ after initiating ustekinumab therapy.
- HZ manifestations occurred 1 and 9 months post-treatment initiation.
Findings:
- The occurrence of HZ suggests a potential causal link with ustekinumab.
- Ustekinumab's inhibition of IL-12/IL-23 may alter immune response, potentially impairing antiviral defenses.
Implications:
- Ustekinumab may be a risk factor for developing herpes zoster.
- Pre-treatment HZ vaccination should be considered for patients undergoing ustekinumab therapy.
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