Combining certain psoriatic disease treatments can raise shingles risk

| Melissa Leavitt

If you had chicken pox as a child, you probably know you are at risk for shingles as an adult.

Now, a growing body of research suggests that people with psoriatic disease taking certain treatments may be at an increased risk for shingles.

About a million people in the United States get shingles each year, according to the National Institutes of Health.

According to a study published in March in JAMA Dermatology, people with psoriasis who take a combination of methotrexate and a biologic have a significantly increased risk for shingles, compared to patients not taking a systemic treatment.

The research team, based in Israel, analyzed patient records from a large Israeli medical database known as the Clalit Health Services database. The study included 95,941 patients with psoriasis. Researchers identified 4,636 cases of shingles within this group, and looked for any associations between shingles and the type of treatment these patients were taking.

The treatments investigated in the study included methotrexate and biologics, as well as Soriatane (acitretin), cyclosporine and phototherapy.

Although patients taking a combination of methotrexate and a biologic were significantly more likely to be diagnosed with shingles, researchers did not find a significantly increased risk associated with taking methotrexate or a biologic alone, or with any other therapy studied, according to the results.

Because having a compromised immune system is a known risk factor for shingles, this increased risk could be caused by the immunosuppressive effects of these drugs, the researchers noted.

In September, the same research team published results from a study of shingles risk in people with psoriatic arthritis, finding that taking a combination of a biologic and a kind of systemic drug known as disease-modifying anti-rheumatic drugs (DMARDs) significantly increased a patient’s risk of shingles.

Based on these findings, researchers recommend that psoriatic disease patients taking these combinations of drugs be alert to the signs and symptoms of shingles. These patients should also consider getting vaccinated for shingles, the researchers concluded. Because the herpes zoster vaccine is a live vaccine, patients should receive it before starting systemic or biologic treatments, the researchers noted. The National Psoriasis Foundation Medical Board recommends that people taking biologics not receive live vaccines, including the herpes zoster vaccine.


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For more than 50 years, we’ve been driving efforts to cure psoriatic disease and improve the lives of those affected. But there’s still plenty to do! Learn how you can help our advocacy team shape the laws and policies that affect people with psoriasis and psoriatic arthritis – in your state and across the country. Help us raise funds to support research by joining Team NPF, where you can walk, run, cycle, play bingo or create your own fundraising event. If you or someone you love needs free, personalized support for living a healthier life with psoriatic disease, contact our Patient Navigation Center. And keep the National Psoriasis Foundation going strong by making a donation today. Together, we will find a cure.

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