Study: Corticosteroids May Increase Risk of Herpes Zoster for Individuals With Psoriasis


The results of a network analyses show that the elevated potential of contracting the virus is also linked to infliximab and tofacitinib, as well as several combination treatments.

A network meta-analyses showed that corticosteroids, infliximab, and tofacitinib, as well as several combination treatments, could lead to a higher risk of herpes zoster in individuals with psoriasis and psoriatic arthritis, according to the results of a study published in Therapeutic Advances in Chronic Disease.

Additionally, investigators said that the differences in herpes zoster risk should be taken into consideration when physicians consider psoriasis treatment.

The network meta-analyses (NMA) include 13 studies with 19 treatment arms and a total of 443,104 individuals with psoriatic disease.

Investigators examined anti-tumor necrosis factor-α, conventional synthetic disease-modifying anti-rheumatic drugs, corticosteroids, infliximab, and Janus kinase inhibitors, in the analyses. They found that corticosteroid treatments had the highest risk of herpes zoster, followed by infliximab and then tofacitinib.

Additionally, they found that acitretin, anti-interleukin-12/23, anti-interleukin-17, anti-interleukin-23, phosphodiesterase-4 inhibitor, and phototherapy all had similar risk to the control in the study with no notable differences.

Investigators also found that recent meta-analyses with elevated herpes zoster risk in individuals with rheumatoid arthritis treated with anti-tumor necrosis factor-α treatments compared with non-biologic disease-modifying anti-rheumatic drugs.

However, they said that few studies evaluated herpes zoster risk in individuals with psoriasis treated with anti-tumor necrosis factor-α treatments.

The results of these studies were consistent with the investigator’s NMA, which suggested that anti-tumor necrosis factor-α treatments may be associated with an increased risk of herpes zoster.

Investigators searched the Cochrane Library, Embase, PubMed, and Web of Sciences databases for relevant studies that were published up to April 2021. They included individuals with the risk of herpes zoster who had psoriatic disease, including psoriasis and psoriatic arthritis.

The 2 reviewers searched the databases and determined the suitability of all the abstracts they reviewed. The studies were included for analysis if they were a phase 2 or 3 randomized controlled trials, a long-term extension or open-label extension studies, prospective registry studies, and cohort studies. The studies had to be about individuals with psoriatic disease who had received at least 1 systemic treatment for the disease, collected data on herpes zoster, investigated and reported on the incidence of herpes zoster of individuals on the treatment or placebo, and were published in English.

The data were determined with a standardized data extraction form, and the network meta-analyses was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Investigators used the incidence rate ratio to determine the differences in herpes zoster among the different treatments tested. They also used a random-effects model for direct pairwise comparisons and network meta-analyses.

Because of the network meta-analyses, investigators were able to analyze direct and indirect comparisons of these multiple treatments across randomized controlled trials. Investigators noted that some of the limitations of the study were that some randomized controlled trials were excluded, because of missing outcome values. In those trials, herpes zoster was not reported as a separate entity but as an adverse event.


Chiu H-Y, Hung Y-T, Huang S-W, Huang Y-H. Comparative risk of herpes zoster in patients with psoriatic disease on systemic treatments: a systematic review and network meta-analysis. Ther Advanc Chron Dis. 2022;13:20406223221091188 doi:10.1177/20406223221091188

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