While drugs that inhibit tumor necrosis factor-a (TNF-a) have become an important part of treatment for people with rheumatoid arthritis (RA), the use of these agents may significantly raise the risk of herpes zoster.

Anti-TNF-a agents have been linked with a heightened risk of bacterial and fungal infections, but little is known about their role in the reactivation of latent viral infections, according to Anja Strangfeld, MD, of the German Rheumatism Research Centre in Berlin, and co-investigators (JAMA. 2009;301:737-744) (subscription required). To that end, they evaluated 5,040 patients receiving monoclonal anti-TNF-a antibodies (infliximab [Remicade] or adalimumab [Humira]); another TNF blocker with a slightly different mechanism of action—etanercept (Enbrel); or conventional RA medications.

Of the 86 shingles episodes that occurred in 82 patients, 39 (45%) could be attributed to treatment with infliximab or adalimumab. Although 23 cases of shingles developed in etanercept patients (nearly 28% of total shingles cases), this association was not considered significant.

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