title: Herpes Zoster Reactivation in Patients With Rheumatoid Arthritis: Analysis of Disease Characteristics and Disease-Modifying Antirheumatic Drugs.
abstract: OBJECTIVE
  To identify the rheumatoid arthritis (RA) characteristics associated with increased herpes zoster (HZ) risk in the Corrona registry RA patients, and to evaluate the risk in initiators of tumor necrosis factor inhibitors (TNFi) or non-TNFi biologic agents or (among those who were currently on or had been previously treated with methotrexate [MTX]) conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) other than MTX.
  
  
  METHODS
  Cox regression modeling estimated the association between first HZ incidence and selected RA characteristics, including disease activity. Medication-related risk for HZ in RA patients taking current or past MTX (to exclude milder RA disease) were categorized by treatment initiation (TNFi versus non-TNFi versus csDMARD). Hazard ratios (HRs) estimated HZ risk of each treatment initiation category after stratification on trimmed propensity score (PS) quintiles to control for potential confounders.
  
  
  RESULTS
  A total of 28,852 patients contributed 95,287 person-years. Seven hundred twenty-nine observed HZ cases yielded a 7.7 (95% confidence interval [95% CI] 7.1-8.2) per 1,000 patient-years crude incidence rate, lower than found in prior RA cohorts. However, consistent with prior studies, increasing age (HR 1.14, 95% CI 1.09-1.19 per 5 years) and prednisone therapy ≥7.5 mg/day (HR 1.81, 95% CI 1.23-2.67) were associated with a higher HZ risk. Referent to TNFi exposure, PS-stratified analysis showed an HR for csDMARDs of 1.36 (95% CI 0.82-2.25) and for non-TNFi of 0.83 (95% CI 0.51-1.38).
  
  
  CONCLUSIONS
  In the Corrona registry, the HZ risk in RA patients taking prior or current MTX increased with older age and higher prednisone dose. The HZ risk among these patients with RA was comparable after initiation of TNFi versus non-TNFi versus csDMARDs.
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, New York, and Corrona, Southborough, Massachusetts.
authors.forename: Dimitrios A
authors.initials: DA
authors.lastname: Pappas
authors.affiliation: Amgen, Thousand Oaks, California.
authors.forename: Michele M
authors.initials: MM
authors.lastname: Hooper
authors.affiliation: Albany Medical Center, Albany, New York, and Corrona, Southborough, Massachusetts.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Kremer
authors.affiliation: Corrona, Southborough, and University of Massachusetts, Worcester, Massachusetts.
authors.forename: George
authors.initials: G
authors.lastname: Reed
authors.affiliation: Corrona, Southborough, Massachusetts.
authors.forename: Ying
authors.initials: Y
authors.lastname: Shan
authors.affiliation: Amgen, Thousand Oaks, California.
authors.forename: Deborah
authors.initials: D
authors.lastname: Wenkert
authors.affiliation: Corrona, Southborough, Massachusetts, and New York University School of Medicine, New York.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Greenberg
authors.affiliation: University of Alabama at Birmingham.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D005260:Female; D006562:Herpes Zoster / Q000453:epidemiology / Q000276:immunology / Q000821:virology*; D014645:Herpesvirus 3, Human / Q000276:immunology / Q000472:pathogenicity*; D006801:Humans; D016867:Immunocompromised Host; D015994:Incidence; D008297:Male; D008727:Methotrexate / Q000009:adverse effects; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011241:Prednisone / Q000009:adverse effects; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000276:immunology; D014481:United States / Q000453:epidemiology; D014775:Virus Activation
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D011241:Prednisone; D008727:Methotrexate