(4) Comparative Risk of Herpes Zoster and Postherpetic Neuralgia in Patients with Psoriasis Receiving IL-17 Inhibitor and IL-12/23 Inhibitor Versus Traditional Systemic Immunosuppressants

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1049

Presenting Author(s)

Edward Lai, PhD
– Associate Professor, National Cheng Kung University, National Cheng Kung University, Tainan City, Tainan, Taiwan (Republic of China)

Co-Author(s)

Chaw-Ning Lee
– School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Miyuki Hsing-Chun Hsieh
– NCKU Institute of Clinical Pharmacy and Pharmaceutical Sciences, Chiayi City, Taiwan
Che-Yu Chen
– NCKU Institute of Clinical Pharmacy and Pharmaceutical Sciences, Tainan, Tainan, Taiwan
Chao-Chun Yang
– Departments of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)
Tzu-Chi Liao
– School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Taiwan (Republic of China)

Background: Previous study suggested that use of TNF-alpha inhibitors (TNFi) may increase the risk of herpes zoster (HZ). Lack of information for the comparison of IL-17 inhibitor (IL17i) or IL-12/23 inhibitor (IL12/23i) with conventional systemic immunosuppressants (TSI) on the risk of HZ in patients with psoriasis. Furthermore, evaluation on the risk of postherpetic neuralgia (PHN) is scarce.

Objectives: To compare the risk of HZ and PHN in patients with psoriasis receiving IL17i and IL12/23i versus TSI.

Methods: We conducted a retrospective cohort study by analyzing data from National Health Insurance Database (NHID 2004-2018) in Taiwan. We included adult patients aged 20 years and above diagnosed with psoriasis or psoriatic arthritis (ICD-9-CM 696, ICD-10-L40) receiving biologics (etanercept, adalimumab, ustekinumab, secukinumab, ixekizumab) or TSI (methotrexate, cyclosporine, acitretin) for more than three months. Primary outcome of study was diagnosis of HZ (ICD-9-CM 053, ICD-10-B02) and the secondary outcome was diagnosis of PHN ((ICD-9-CM 053, ICD-10-B02) and the use of low level laser therapy ≥1 (51032B) or analgesics for at least 6 weeks. The patients were followed from initiation of IL17i and IL12/23i or TSI for 2 years or until the occurrence of outcome or death. We performed Multivariable Cox proportional-hazards models to compare the risk of HZ and PHN between IL17i, IL12/23i with the reference group of TSI, with adjustment of patients’ age, sex, comorbidities and co-medications.

Results: We identified a total of 400 and 1678 patients with psoriasis receiving IL17i and IL12/23i group with the average age of patients 46.6 (SD 13.1) and 46.4 (SD 13.6) years, respectively. We found the incidence rates of HZ were 6.8, 14.5 and 12.7 per 1000 person-years for IL17i, IL12/23i and TSI groups, respectively. Comparing with patients receiving TSI, we found the risk of IL17i (adjusted hazard ratio, 0.64; 95% CI, 0.16- 2.58) and IL12/23i (1.36; 0.98- 1.88) was not associated with increased risk of HZ. The incidence rates of PHN were 0.0, 2.4 and 2.9 per 1000 person-years for IL17i, IL12/23i and TSI groups, respectively. No statistically significant difference was found among IL17i, IL12/23i and TSI groups on the risk of PHN.

Conclusions: The findings suggested that patients receiving IL17i and IL12/23i were not associated with increased risk of HZ and PHN comparing with those receiving TSI.