抗腫瘤壞死因子製劑不會增加僵直性脊椎炎患者帶狀皰疹的發生風險

Tumor Necrosis Factor Inhibitors Do Not Increase The Risk of Herpes Zoster in Patients with Ankylosing Spondylitis

目的：在使用生物製劑的僵直性脊椎炎患者，產生帶狀皰疹的風險是否會增加目前仍未知。此研究目的為了解帶狀皰疹在僵直性脊椎炎患者的發生率是否增加，以及使用抗腫瘤壞死因子製劑是否增加風險。方法：本回溯性研究將2005至2019年期間，符合診斷標準的僵直性脊椎炎患者納入並分成兩組，一組為使用抗腫瘤壞死因子製劑的患者，一組則沒有使用。兩組病人追蹤年限始於診斷僵直性脊椎炎，直至帶狀皰疹發病，或是追蹤滿十年為止。本研究比較帶狀皰疹在兩組的發生率，亦以Cox-regression model進行帶狀皰疹風險因子分析。結果：本研究共收錄103位僵直性脊椎炎患者，其中包含27（26.2％）位女性，平均診斷僵直性脊椎炎的年齡為38歲。在這些患者中，有52（50.4％）位使用抗腫瘤壞死因子製劑治療。在使用抗腫瘤壞死因子製劑的組別，患者的疾病活動度比未使用組別高，且使用口服抗風濕病藥物的人也較多，兩者皆有顯著性差異。再者，帶狀皰疹的發生率在使用抗腫瘤壞死因子製劑的患者中為7.7％，在未使用的患者為3.9％，P值為0.678未達顯著性差異。另外，以Cox regression model進行帶狀皰疹的風險因子分析，最後顯示診斷僵直性脊椎炎的年齡是唯一達到統計顯著性的因子，且使用口服抗風濕病藥物及生物製劑治療並非風險因子。結論：在僵直性脊椎炎患者中，使用抗腫瘤壞死因子製劑治療並非造成帶狀皰疹發生的風險因子。

Objective: In patients with ankylosing spondylitis (AS), whether receiving biologics increases the risks of herpes zoster (HZ) is unknown. We investigated the incidence of HZ in AS patients and determined if tumor necrosis factor inhibitors (TNFi) might be a risk factor. Methods: Patients meeting the 1984 Modified New York criteria for AS in a medical center were retrospectively enrolled from 2005 to 2019, divided into the TNFi and non-TNFi treatment groups. Follow-up duration was 10 years or until HZ development from time of initial diagnosis or start of TNFi. Characteristics including disease activity, treatments, and HZ incidence were analyzed. Risk factors for HZ were identified using the cox regression model. Results: A total of 103 patients, including 27 (26.2%) females, were enrolled, mean age at diagnosis being 38 years. Among them, 52 (50.4%) had been treated with TNFi. In this group, the patients' disease activity was significantly higher, and the use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was significantly more frequent compared to the control group. The incidence of HZ was higher in the TNFi group (7.7%) than the non-TNFi group (3.9%) (P=0.678). Further adjustment by the multivariate analysis for gender, disease activity, and treatment showed that age at diagnosis of AS was an independent risk factor for HZ (adjusted HR 1.057, 95% CI: 1.001-1.117, P=0.048). Conclusions: Receiving TNFi was not a risk factor for HZ in AS patients. However, further studies are needed to clarify the role of TNFi in the reactivation of HZ in AS patients.