Herpes zoster in psoriasis patients treated with tofacitinib

Kevin L Winthrop; Mark Lebwohl; Arnon D Cohen; Jeffrey M Weinberg; Stephen K Tyring; Scott T Rottinghaus; Pankaj Kumar Gupta; Kaori Ito; Huaming Tan; Mandeep Kaur; Alexander Egeberg; Lotus Mallbris; Hernan Valdez

doi:10.1016/j.jaad.2017.03.023

Herpes zoster in psoriasis patients treated with tofacitinib

Kevin L Winthrop, Mark Lebwohl, Arnon D Cohen, Jeffrey M Weinberg, Stephen K Tyring, Scott T Rottinghaus, Pankaj Kumar Gupta, Kaori Ito, Huaming Tan, Mandeep Kaur, Alexander Egeberg, Lotus Mallbris, Hernan Valdez

Allergi, Hud- og Kønssygdomme

59 Citationer (Scopus)

Abstract

BACKGROUND: Tofacitinib is an oral Janus kinase (JAK) inhibitor. Immunomodulatory therapies can increase the risk for herpes zoster (HZ) in patients with psoriasis.

OBJECTIVE: To evaluate the relationship between tofacitinib use and HZ risk.

METHODS: We used phases 2 and 3 and long-term extension (LTE) data from the tofacitinib development program in psoriasis to calculate HZ incidence rates (IR; events per 100 patient-years); potential HZ risk factors were evaluated using Cox-proportional hazard models.

RESULTS: One hundred thirty (3.6%) patients on tofacitinib (IR 2.55), no patients on placebo, and 2 using etanercept (IR 2.68) developed HZ. Nine patients (7%) were hospitalized, and 8 (6%) had multidermatomal HZ; no encephalitis, visceral involvement, or deaths occurred. In total, 121 (93%) patients on tofacitinib continued or resumed use after HZ. HZ risk factors included Asian descent (hazard ratio [HR] 2.92), using tofacitinib 10 mg twice daily (vs 5 mg twice daily; HR 1.72), prior use of biologics (HR 1.72), and older age (HR 1.30).

LIMITATIONS: Generalizability to other psoriasis populations might be limited. The effect of HZ vaccination was not studied.

CONCLUSION: Tofacitinib is associated with increased HZ risk relative to placebo. Asian race, increasing age, higher dose, and prior biologic exposure are associated with heightened risk.

Originalsprog	Engelsk
Tidsskrift	Journal of the American Academy of Dermatology
Vol/bind	77
Udgave nummer	2
Sider (fra-til)	302-309
Antal sider	8
ISSN	0190-9622
DOI	https://doi.org/10.1016/j.jaad.2017.03.023
Status	Udgivet - aug. 2017

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10.1016/j.jaad.2017.03.023

Citationsformater

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title = "Herpes zoster in psoriasis patients treated with tofacitinib",

abstract = "BACKGROUND: Tofacitinib is an oral Janus kinase (JAK) inhibitor. Immunomodulatory therapies can increase the risk for herpes zoster (HZ) in patients with psoriasis.OBJECTIVE: To evaluate the relationship between tofacitinib use and HZ risk.METHODS: We used phases 2 and 3 and long-term extension (LTE) data from the tofacitinib development program in psoriasis to calculate HZ incidence rates (IR; events per 100 patient-years); potential HZ risk factors were evaluated using Cox-proportional hazard models.RESULTS: One hundred thirty (3.6%) patients on tofacitinib (IR 2.55), no patients on placebo, and 2 using etanercept (IR 2.68) developed HZ. Nine patients (7%) were hospitalized, and 8 (6%) had multidermatomal HZ; no encephalitis, visceral involvement, or deaths occurred. In total, 121 (93%) patients on tofacitinib continued or resumed use after HZ. HZ risk factors included Asian descent (hazard ratio [HR] 2.92), using tofacitinib 10 mg twice daily (vs 5 mg twice daily; HR 1.72), prior use of biologics (HR 1.72), and older age (HR 1.30).LIMITATIONS: Generalizability to other psoriasis populations might be limited. The effect of HZ vaccination was not studied.CONCLUSION: Tofacitinib is associated with increased HZ risk relative to placebo. Asian race, increasing age, higher dose, and prior biologic exposure are associated with heightened risk.",

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author = "Winthrop, {Kevin L} and Mark Lebwohl and Cohen, {Arnon D} and Weinberg, {Jeffrey M} and Tyring, {Stephen K} and Rottinghaus, {Scott T} and Gupta, {Pankaj Kumar} and Kaori Ito and Huaming Tan and Mandeep Kaur and Alexander Egeberg and Lotus Mallbris and Hernan Valdez",

year = "2017",

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doi = "10.1016/j.jaad.2017.03.023",

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T1 - Herpes zoster in psoriasis patients treated with tofacitinib

AU - Winthrop, Kevin L

AU - Lebwohl, Mark

AU - Cohen, Arnon D

AU - Weinberg, Jeffrey M

AU - Tyring, Stephen K

AU - Rottinghaus, Scott T

AU - Gupta, Pankaj Kumar

AU - Ito, Kaori

AU - Tan, Huaming

AU - Kaur, Mandeep

AU - Egeberg, Alexander

AU - Mallbris, Lotus

AU - Valdez, Hernan

PY - 2017/8

Y1 - 2017/8

N2 - BACKGROUND: Tofacitinib is an oral Janus kinase (JAK) inhibitor. Immunomodulatory therapies can increase the risk for herpes zoster (HZ) in patients with psoriasis.OBJECTIVE: To evaluate the relationship between tofacitinib use and HZ risk.METHODS: We used phases 2 and 3 and long-term extension (LTE) data from the tofacitinib development program in psoriasis to calculate HZ incidence rates (IR; events per 100 patient-years); potential HZ risk factors were evaluated using Cox-proportional hazard models.RESULTS: One hundred thirty (3.6%) patients on tofacitinib (IR 2.55), no patients on placebo, and 2 using etanercept (IR 2.68) developed HZ. Nine patients (7%) were hospitalized, and 8 (6%) had multidermatomal HZ; no encephalitis, visceral involvement, or deaths occurred. In total, 121 (93%) patients on tofacitinib continued or resumed use after HZ. HZ risk factors included Asian descent (hazard ratio [HR] 2.92), using tofacitinib 10 mg twice daily (vs 5 mg twice daily; HR 1.72), prior use of biologics (HR 1.72), and older age (HR 1.30).LIMITATIONS: Generalizability to other psoriasis populations might be limited. The effect of HZ vaccination was not studied.CONCLUSION: Tofacitinib is associated with increased HZ risk relative to placebo. Asian race, increasing age, higher dose, and prior biologic exposure are associated with heightened risk.

AB - BACKGROUND: Tofacitinib is an oral Janus kinase (JAK) inhibitor. Immunomodulatory therapies can increase the risk for herpes zoster (HZ) in patients with psoriasis.OBJECTIVE: To evaluate the relationship between tofacitinib use and HZ risk.METHODS: We used phases 2 and 3 and long-term extension (LTE) data from the tofacitinib development program in psoriasis to calculate HZ incidence rates (IR; events per 100 patient-years); potential HZ risk factors were evaluated using Cox-proportional hazard models.RESULTS: One hundred thirty (3.6%) patients on tofacitinib (IR 2.55), no patients on placebo, and 2 using etanercept (IR 2.68) developed HZ. Nine patients (7%) were hospitalized, and 8 (6%) had multidermatomal HZ; no encephalitis, visceral involvement, or deaths occurred. In total, 121 (93%) patients on tofacitinib continued or resumed use after HZ. HZ risk factors included Asian descent (hazard ratio [HR] 2.92), using tofacitinib 10 mg twice daily (vs 5 mg twice daily; HR 1.72), prior use of biologics (HR 1.72), and older age (HR 1.30).LIMITATIONS: Generalizability to other psoriasis populations might be limited. The effect of HZ vaccination was not studied.CONCLUSION: Tofacitinib is associated with increased HZ risk relative to placebo. Asian race, increasing age, higher dose, and prior biologic exposure are associated with heightened risk.

KW - Journal Article

U2 - 10.1016/j.jaad.2017.03.023

DO - 10.1016/j.jaad.2017.03.023

M3 - Journal article

C2 - 28711084

SN - 0190-9622

VL - 77

SP - 302

EP - 309

JO - Journal of the American Academy of Dermatology

JF - Journal of the American Academy of Dermatology

IS - 2

ER -

Herpes zoster in psoriasis patients treated with tofacitinib

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