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Herpes Zoster Risk in Rheumatoid Arthritis Patients on Janus Kinase Inhibitors: A 17-Year Experience from Rheumatoid

Ola Abudaowd1, Suzan M Attar2, Muhammad Irfanullah Siddiqui3

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Summary
This summary is machine-generated.

Janus kinase inhibitors (JAKi) did not increase herpes zoster (HZ) risk in rheumatoid arthritis (RA) patients. However, Asian ethnicity and high cumulative glucocorticoid (GC) exposure were linked to higher HZ incidence.

Keywords:
DMARDsglucocorticoidsinfectiontofacitinibvaricella zoster infection

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Area of Science:

  • Rheumatology
  • Immunology
  • Infectious Diseases

Background:

  • Biologic disease-modifying anti-rheumatic drugs (bDMARDs) and Janus kinase inhibitors (JAKi) have transformed rheumatoid arthritis (RA) treatment.
  • Concerns exist regarding increased infection risk, particularly herpes zoster (HZ), with these advanced therapies.

Purpose of the Study:

  • To evaluate the risk of HZ in RA patients treated with JAKi and other disease-modifying anti-rheumatic drugs (DMARDs).
  • To analyze HZ risk factors within the Rheumatoid Arthritis Saudi Database (RASD).

Main Methods:

  • A 17-year retrospective multicenter chart review of RA patients in Saudi Arabia.
  • Inclusion criteria: RA diagnosis, age ≥18, various DMARD treatments (csDMARDs, bDMARDs, tsDMARDs) with or without glucocorticoids (GC).
  • Data collected: demographics, comorbidities, medications, HZ occurrence, and vaccination history.

Main Results:

  • Herpes zoster (HZ) occurred in 1.1% of 614 RA patients.
  • No significant association was found between Janus kinase inhibitor (JAKi) therapy and HZ risk (p = 0.454).
  • Asian ethnicity (p = 0.010) and cumulative GC exposure ≥60 mg (p = 0.035) were significantly associated with increased HZ risk.

Conclusions:

  • Janus kinase inhibitors (JAKi) were not associated with an increased risk of herpes zoster (HZ) in this RA cohort.
  • Cumulative glucocorticoid (GC) use and Asian ethnicity emerged as significant risk factors for HZ.
  • Findings support developing personalized preventive strategies against HZ in RA patients.