There is limited information regarding disease-modifying antirheumatic drug (DMARD)-dependent risks of overall, incident, and recurrent herpes zoster (HZ) during first-line biologic DMARD (bDMARD) or targeted synthetic DMARD (tsDMARD) treatment among patients with seropositive rheumatoid arthritis (RA) in terms of HZ risk. A total of 11,720 patients with seropositive RA who were prescribed bDMARD or tofacitinib between January 2011 and January 2019 from the Korean Health Insurance Review & Assessment Service database were studied. A multivariate Cox proportional hazards regression model was adopted to evaluate the adjusted hazard ratio (aHR) with 95% confidence interval (CI) for the risk of HZ dependent on the choice of first-line bDMARDs or tsDMARD, including etanercept, infliximab, adalimumab, golimumab, tocilizumab, rituximab, tofacitinib, and abatacept. During the 34,702 person-years of follow-up, 1686 cases (14.4%) of HZ were identified, including 1372 (11.7%) incident and 314 (2.7%) recurrent HZs. Compared with that of the abatacept group, tofacitinib increased the overall risk (aHR, 2.46; 95% CI, 1.61–3.76; P<0.001), incidence (aHR, 1.99; 95% CI, 1.18–3.37; P=0.011), and recurrence (aHR, 3.69; 95% CI, 1.77–7.69; P<0.001) of HZ. Infliximab (aHR, 1.36; 95% CI, 1.06–1.74; P=0.017) and adalimumab (aHR, 1.29; 95% CI, 1.02–1.64; P=0.032) also increased the overall HZ risk. Moreover, a history of HZ was found to be an independent risk factor for HZ (aHR, 1.54; 95% CI, 1.33–1.78; P<0.001). HZ risk is significantly increased in RA patients with a history of HZ after the initiation of bDMARDs or tsDMARD. The risk of incident and recurrent HZ was higher after tofacitinib treatment in patients with RA than that after treatment with bDMARDs. Individualized characteristics and history of HZ should be considered when selecting bDMARDs or tsDMARD for RA patients considering HZ risks.

中文翻译：

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血清反应阳性类风湿关节炎患者一线 bDMARD 和 tsDMARD 使用者的事件和复发性带状疱疹：一项全国性队列研究

在血清学阳性类风湿病患者中，在一线生物 DMARD (bDMARD) 或靶向合成 DMARD (tsDMARD) 治疗期间，关于改善疾病的抗风湿药 (DMARD) 依赖的总体、事件和复发性带状疱疹 (HZ) 风险的信息有限关节炎 (RA) 的 HZ 风险。研究了韩国健康保险审查与评估服务数据库中在 2011 年 1 月至 2019 年 1 月期间使用 bDMARD 或托法替尼处方的 11,720 名血清阳性 RA 患者。采用多变量 Cox 比例风险回归模型评估 HZ 风险的调整风险比 (aHR) 和 95% 置信区间 (CI)，取决于一线 bDMARD 或 tsDMARD 的选择，包括依那西普、英夫利昔单抗、阿达木单抗、戈利木单抗、托珠单抗、利妥昔单抗、托法替尼、和阿巴西普。在 34,702 人年的随访中，共发现 1686 例（14.4%）HZ，其中 1372 例（11.7%）事件和 314 例（2.7%）复发 HZ。与阿巴西普组相比，托法替尼增加了总体风险（aHR，2.46；95% CI，1.61-3.76；P<0.001），发病率（aHR，1.99；95% CI，1.18-3.37；P=0.011），和 HZ 的复发（aHR，3.69；95% CI，1.77-7.69；P<0.001）。英夫利昔单抗（aHR，1.36；95% CI，1.06-1.74；P=0.017）和阿达木单抗（aHR，1.29；95% CI，1.02-1.64；P=0.032）也增加了整体 HZ 风险。此外，发现 HZ 病史是 HZ 的独立危险因素（aHR，1.54；95% CI，1.33-1.78；P<0.001）。在开始使用 bDMARD 或 tsDMARD 后，有 HZ 病史的 RA 患者的 HZ 风险显着增加。RA 患者接受托法替尼治疗后发生和复发 HZ 的风险高于接受 bDMARDs 治疗后的风险。在考虑 HZ 风险的 RA 患者选择 bDMARD 或 tsDMARD 时，应考虑 HZ 的个体化特征和病史。