Incidence and risk of hospitalisation due to shingles and chickenpox in patients with rheumatic diseases treated with TNF antagonists.
OBJECTIVE
To estimate the incidence of hospitalisation due to varicella zoster virus (VZV) infection in patients treated with tumour necrosis factor (TNF) antagonists for inflammatory rheumatic conditions and to compare it with the expected rate in the general population.


METHODS
Secondary data analysis was performed of two large databases: (1) the national registry of rheumatic diseases patients treated with biological agents (BIOBADASER); and (2) the national hospital discharge database Conjunto Mínimo Básico de Datos al Alta Hospitalaria. Hospitalisations due to shingles or chickenpox were analysed. For each condition the incidence rate (IR) and the age and gender standardised IR per 100,000 person-years plus the standardised incidence ratio (SIR) and the standardised incidence difference (SID) were estimated.


RESULTS
In patients exposed to TNF antagonists, the estimated IR of hospitalisation due to shingles was 32 cases per 100,000 patient-years (95% CI 14 to 78), the expected rate in the general population was 3.4 (95% CI 3.2 to 3.5), the SIR was 9 (95% CI 3 to 20) and the SID was 26 (95% CI 14 to 37). The estimated IR of hospitalisation due to chickenpox was 26 cases per 100,000 (95% CI 10 to 69), the expected rate was 1.9 (95% CI 1.8 to 2.0), the SIR was 19 (95% CI 5 to 47) and the SID 33 (95% CI 21 to 45).


CONCLUSIONS
Patients suffering rheumatic diseases exposed to TNF antagonists are hospitalised due to VZV infections significantly more frequently than expected in the general population. Since the absolute IR of hospitalisations due to chickenpox and shingles is low in these patients, the implementation of risky preventive measures may not be justified at present.
García-Doval
Ignacio
I
Dermatology Department, Complexo Hospitalario de Pontevedra, Pontevedra, Spain.
Pérez-Zafrilla
Beatriz
B
Descalzo
Miguel Angel
MA
Roselló
Rosa
R
Hernández
Maria Victoria
MV
Gómez-Reino
Juan J
JJ
Carmona
Loreto
L
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D002644:Chickenpox / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D005260:Female; D006562:Herpes Zoster / Q000150:complications* / Q000453:epidemiology / Q000276:immunology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications / Q000453:epidemiology / Q000276:immunology; D012042:Registries; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D013030:Spain / Q000453:epidemiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha