Psoriasis Treatment With Biologic, Systemic Therapies Has No Effect on Herpes Zoster Risk

Psoriasis on elbow
Psoriasis on elbow
There was little difference in risk of herpes zoster among patients who were or weren't taking biologic or systemic therapies.

In patients with moderate to severe psoriasis, no significant difference in the risk for herpes zoster (HZ) virus infection has been reported in patients receiving biologic or systemic therapy vs nonbiologic or no systemic therapy, according to the results of a recent cohort study conducted at Kaiser Permanente Northern California (KPNC) and published in JAMA Dermatology.

The investigators examined a cohort of adult KPNC health care members with systematically treated psoriasis that had been diagnosed between 1998 and 2011. Medication use was extracted from pharmacy databases for biologic agents (adalimumab, etanercept, infliximab, ustekinumab, golimumab, certolizumab, tocilizumab, abatacept, anakinra, and rituximab) and nonbiologic agents (methotrexate, retinoids, cyclosporine, hydroxyurea, mycophenolate mofetil, sulfasalazine, and thioguanine). All participants were followed through December 31, 2012 for the development of incident HZ.

A total of 5889 patients with systematically treated psoriasis were enrolled in the study, with 291 of the participants being diagnosed with HZ during follow-up. Of the 5889 patients, 2258 were treated with a biologic agent and 3631 with a nonbiologic agent. In the 291 patients who developed HZ, crude incidence rates (IRs) per 100 person-years showed that when compared with participants not receiving systemic therapy at the time of HZ diagnosis, patients receiving systemic therapy had a statistically nonsignificant increased risk for HZ (IR 8.6%; 95% CI, 7.1-10.0 and IR 10.2%; 95% CI, 8.6-11.8, respectively; P =.14).

Following adjustment for age and gender, no significant differences were reported between patients receiving no systemic therapy (adjusted IR [aIR] 6.1%; 95% CI, 4.1-8.1), patients receiving any type of systemic therapy (aIR 8.1%; 95% CI, 5.3-11.0), patients receiving biologic agents only (aIR 7.8%; 95% CI, 4.1-11.5), patients receiving nonbiologic agents only (aIR 8.9%; 95% CI, 4.1-13.6), or patients receiving combination therapy (aIR 5.6%; 95% CI, 1.2-10.0).

Related Articles

The investigators concluded that no significant differences were observed for risk for HZ infection in patients treated with systemic therapy vs no systemic therapy. Moreover, no significant differences were reported in systematically treated patients who received a biologic agent vs a nonbiologic agent. These findings suggest that in systematically treated patients with moderate to severe psoriasis, biologic agents may preferentially inhibit immune mechanisms specific for bacterial defense while sparing cell-mediated immune responses specific for maintaining varicella zoster virus latency.


Levandoski KA, Quesenberry CP, Tsai AL, Asgari MM. Herpes zoster rates in a large cohort of patients with systemically treated psoriasis [published online December 20, 2017]. JAMA Dermatol. doi:10.1001/jamadermatol.2017.4840