Hz risk with biological psoriasis

Topline:

Patients with moderate to severe psoriasis treated with Untkinumab and Guselkumab have shown a tendency to lower risk for Herpes Zoster (HZ) and postherpetic neuralgia (PHN) than those receiving traditional systemic treatments. Adalimumab was associated with a significantly higher risk for Hz.

METHODOLOGY:

• The researchers carried out a retrospective cohort study of patients with psoriasis or psoriatic arthritis from the national health insurance research base in 2011-2021, who were treated with biological (6769 patients) or traditional systemic treatments (4594 patients) for at least 6 months.
• The biologists received were etanercept (n = 815), adalimumab (n = 1870), untkinumab (n = 1095), Secukinumab (n = 2327), ixekizumab (n = 261), Brodalumab (n = 303) and guselkumab (n = 98). Traditional systemic treatments have involved methotrexate, cyclosporine or acitretine.
• The main result was Hz infections, and the secondary result was PHN later.

TAKE AWAY:

• The incidence rates of Hz at 1000 years-person were the highest for Adalimumab (27.2) and the lowest for Guselkumab (6.6).
• Patients who received Adalimumab showed a significantly higher risk for HZ than those who received traditional systemic treatments (HR hazard (HR), 1.63; 95%, 1.22-2.18).
• Untkinumab (HR, 0.82; IC 95%, 0.61-1.14) and Guselkumab (HR, 0.48; IC 95%, 0.22-1.02) showed tendencies to a lower Hz risk.
• Untkinumab was associated with a significant reduction in PHN risk compared to traditional systemic treatments (HR, 0.22; 95%, 0.08-0.64). There have been no significant differences in the risk of HZ with etanercept, Secukinumab, Ixekizumab or Brodalumab compared to traditional systemic treatments.

IN PRACTICE:

Untkinumab and Guselkini can be associated with a low risk for HZ and PHN compared to traditional systemic treatments, the authors concluded. Although they are not statistically significant in some comparisons, they wrote: “Trends suggest a potential protection effect … These findings could be significant for the practice in the real world, because they underline the need to give priority to biological profiles in clinical practice.”

SOURCE:

This study was conducted by Chaw-Hning Lee, from the Department of Dermatology, Cing Kung National University of Tainan, Taiwan and was published online On March 20 in British Journal of Dermatology.

Limitations:

No data on psoriasis severity scores and Hz vaccination rates were available. The study excluded patients with self -payments, limiting generalization. Some confusion factors may also be present.

Disclosures:

The study was supported by the National Council of Science and Technology in Taiwan and the national health research institutes in Taiwan. The authors did not report any conflict of interest.

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