eISSN: 2299-0046
ISSN: 1642-395X
Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii
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1/2024
vol. 41
 
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abstract:
Original paper

Systematic review and network meta-analysis of the risk of Herpes zoster with biological therapies and selective Janus kinase-1 inhibitors in atopic dermatitis

Daud Manzar
1
,
Nikhil Nair
1
,
Emmanuel Suntres
2
,
Myanca Rodrigues
3
,
Mohannad Abu-Hilal
4

  1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
  2. Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
  4. Division of Dermatology, McMaster University, Hamilton, Ontario, Canada
Adv Dermatol Allergol 2024; XLI (1): 72-77
DOI: https://doi.org/10.5114/ada.2023.135764
Online publish date: 2024/03/15
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Introduction:
Atopic dermatitis (AD) patients have an increased risk of herpes zoster (HZ). The relationship of dupilumab, tralokinumab, upadacitinib, and abrocitinib to HZ incidence in AD patients remains unclear.

Aim:
To evaluate and compare the incidence and risk of HZ among patients with moderate to severe atopic dermatitis treated with advanced systemic therapies.

Material and methods:
Systematic searches were conducted in Ovid Medline and Embase. The primary outcome was incidence of HZ in patients with moderate to severe AD receiving placebo or the aforementioned treatments. A frequentist random-effects NMA was conducted with odds ratio.

Results:
Our search identified 16 trials comprising 10,689 patients. Upadacitinib was associated with a dose-dependent increase in the incidence of HZ compared to placebo (OR = 2.55 [1.09, 5.95] and (OR = 4.29 [1.89, 9.74], respectively) and compared to various dupilumab doses (OR = 4.48 [1.29, 15.57], 3.61 [1.28, 10.18] and 7.54 [2.21, 25.68], 6.09 [2.24, 16.52], respectively). Upadacitinib 30 mg was associated with a higher incidence of HZ when compared to upadacitinib 15 mg (OR = 1.68 [1.19, 2.38]). Abrocitinib 200 mg was associated with a higher increase in HZ compared to placebo (OR = 3.34 [1.34, 8.31]). According to SUCRA ranks, both JAK-1 inhibitors had a higher cumulative incidence of HZ compared to dupilumab.

Conclusions:
JAK-1 inhibitors are associated with a significantly higher incidence of HZ compared to dupilumab and placebo. Our results suggest that recombinant HZ vaccination should be highly considered for all adult patients prior to starting oral JAK-1 inhibitors.

keywords:

atopic dermatitis, dupilumab, JAK-1 inhibitors, herpes zoster, abrocitinib, upadacitinib
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