Herpes Zoster risk with anti-TNF therapy

Winthrop KL, Baddley JW, Chen L, Liu L, Grijalva CG, Delzell E, Et Al. Association Between the Initiation of Anti-Tumor Necrosis Factor Therapy and the Risk of Herpes Zoster. JAMA 2013;309:887–895.

Incidence rate of HZ per 1000 patient-years:

From historical data:

  • 4, age 50 without rheumatoid arthritis
  • 11, age 80 without rheumatoid arthritis
  • Risk for patients with rheumatoid arthritis is 2-3 times higher

From this study:

  • 4, psoriatic arthritis, psoriasis, or AS on anti-TNF
  • 12, rheumatoid arthritis on anti-TNF


Our results suggest that patients initiating anti-TNF drugs are at similar risk of herpes zoster as patients who initiate non-biologic medications, and that herpes zoster risk is similar among different anti-TNF compounds.