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Commentary: Increased risk of herpes zoster in patients prescribed JAK inhibitors

Janus kinase inhibitors (JAKI) are being increasingly used to treat conditions such as inflammatory and immune-mediated diseases.

JAKIs are known to give rise to serious adverse effects such as herpes zoster and in a recent systematic review, researchers attempted to assess the relative risk of adverse events that arise with these drugs. The analysis included 82 studies, two-thirds of which were randomised trials and comprised 66,159 patients. The primary outcome was the incidence rates of both adverse events (AEs) and serious adverse events (SAEs). The majority of studies were in patients with rheumatoid arthritis (53/82) although other conditions included psoriasis, inflammatory bowel disease and ankylosing spondylitis. The median exposure time to a JAKI was 26 weeks although there was a wide variability in treatment duration between studies.

The relative risk of AEs was 1.01 (0.97–1.06) and 0.98 (0.83–1.1.5) for SAEs. The relative risk of herpes zoster infection was 1.57 (1.04 – 2.37) which appeared to be a class effect and was significantly higher than for all other AEs.

The authors concluded that JAKI increased the risk of herpes zoster compared to other adverse effects and called for more real-world studies of longer duration to fully establish the adverse effect profile of this class of drugs.

Olivera PA et al. Safety of Janus Kinase inhibitors in patients with inflammatory bowel diseases or other immune-mediated diseases: a systematic review and meta-analysis. Gastroenterology 2020;158(6):1554-73.

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