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.

Shingles

Chicken Pox

10.1136/ard.2009.125658

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Citations (107)

Non-typhi Salmonella infection in patients with rheumatic diseases on TNF-alpha antagonist therapy.

PubMed (2010)

J L Peña-Sagredo M C Fariñas Beatriz Pérez-Zafrilla Ana Cruz-Valenciano M. Crespo

The morbidity and mortality of patients with rheumatic diseases has improved considerably following the use of biologic therapies. However, an increase in the frequency of bacterial infections has been observed in patients receiving these drugs. In the present study we aimed to establish the incidence and clinical manifestations of non-typhi Salmonella infection in a large cohort of patients with rheumatic diseases undergoing TNF-alpha antagonist therapy due to severe rheumatic diseases refractory to conventional therapies.The rate of non-typhi Salmonella infection found in the Spanish Registry of Adverse Events of Biological Therapies in Rheumatic Diseases (BIOBADASER) was compared with that observed in a cohort of rheumatoid arthritis (RA) patients from the EMECAR (Morbidity and Clinical Expression of Rheumatoid Arthritis) Study, who were not treated with TNF-alpha antagonists. The rate found in the BIOBADASER registry was also compared with that available in a non-RA historic control cohort reported in a population from Huesca (Northern Spain).Seventeen cases of non-typhi Salmonella infection were observed in the series of patients exposed to anti-TNF-alpha therapies. The incidence rate of non-typhi Salmonella in BIOBADASER was 0.73 per 1000 patient-years (95% confidence interval [CI]: 0.45-1.17). The incidence rate in the EMECAR cohort was 0.44 per 1000 patient-years. The relative risk for non-typhi salmonellosis in RA patients exposed to TNF-alpha inhibitors compared to those not treated with biological therapies was 2.07 (95% CI: 0.27-15.73) (p=0.480) whereas the relative risk of non-typhi Salmonella infections in patients with rheumatic diseases undergoing TNF-alpha antagonist therapy compared with the non-RA Spanish control cohort was 0.63 (95% CI: 0.38-1.04) (p=0.07). Nine of the 17 patients with non-typhi salmonellosis presented a severe systemic infection.Incidence of non-typhi Salmonella infection is not increased significantly in rheumatic patients undergoing anti-TNF-alpha therapy when compared with RA patients undergoing conventional DMARD therapy or with the general population. Nevertheless, at least 50% of patients on TNF-alpha have severe complications once they develop non-typhi Salmonella infection. This fact suggests that anti-TNF-alpha therapies may predispose to salmonella dissemination rather than to infection.

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Citations (25)

PP016

Oral Oncology (2013)

José-Antonio Garcı́a-de Marcos Susana Arroyo-Rodrı́guez Beatriz Pérez-Zafrilla Ángel Arriaga-Aragón Enrique Poblet

10.1016/j.oraloncology.2013.03.259

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Citations (0)

Infections in Patients with Rheumatic Diseases Treated with TNF Antagonists

Current Pharmaceutical Biotechnology (2012)

Beatriz Pérez-Zafrilla Loreto Carmona Juan J. Gómez‐Reino

TNF has a critical role in inflammation and immunity, and therapeutic inhibition of TNF with antagonist could potentially lead to immune suppression. Data gathered from clinical trials and clinical observation show a minor but significant increased risk of infections in patients suffering from rheumatic diseases treated with monoclonal TNF antibodies and soluble TNF receptors. This increase risk applies to patients but also to the underlying disease. Pathogens causing these infections include intracellular bacteria, and to some extend opportunistic microorganisms as mycobacteria and fungi. Preventive strategies and patient selection have an important impact on the risk of these infections. Keywords: "Adalimumab"[Substance Name], "ankylosing spondylitis"[Mesh], "etanercept" [Substance Name], "infections"[Mesh], "infliximab" [Substance Name], "rheumatic diseases"[Mesh], "safety"[Mesh], "tumor necrosis factor antagonist"[Mesh]

10.2174/138920112800784808

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Citations (5)

Infections in patients treated with tumor necrosis factor antagonists: incidence, etiology and mortality in the BIOBADASER registry

Medicina Clínica (2011)

María José Pérez-Sola José Miguel Cisneros Beatriz Pérez-Zafrilla Loreto Carmona M.Á. Descalzo

Etiology

Bacterial pneumonia

Mucocutaneous zone

10.1016/j.medcli.2010.11.032

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Citations (87)