Using Methotrexate with Bio's could increase risk of herpes zoster

[Fred]

They are still often recommending using methotreaxte with bio treatments in some cases, this large study of 95,941 patients suggests you may also need to take a herpes zoster preventive vaccine too.

Quote:

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Importance:  
The risk for herpes zoster (HZ) in patients with psoriasis treated with biologic medications or other systemic treatments has been given little attention to date.

Objective:  
To describe the risk for HZ in patients with psoriasis and its relation to treatment.

Design, Setting, and Participants:  
A cohort study was performed using the administrative database of Clalit Health Services, the largest public health care provider organization in Israel, in the setting of general community clinics, primary care and referral centers, and ambulatory and hospitalized care. We extracted information for all patients who received a psoriasis diagnosis from January 2002 to June 2013. Follow-up was conducted until the end of July 2013. The study included 95 941 patients with psoriasis in the analysis, with 522 616 person-years of follow-up. Incidence of HZ events was calculated for each systemic antipsoriatic medication provided, during a follow-up period of 11 years and 7 months. We used a generalized estimating equation Poisson regression model to examine the effect of each systemic treatment for psoriasis on HZ incidence, adjusting for age, sex, psoriasis severity, Charlson comorbidity index, steroid treatment, and socioeconomic status.

Main Outcomes and Measures:  
Incidence of HZ associated with systemic therapies.

Results:  
In a multivariate analysis, it was observed that treatment with phototherapy (rate ratio [RR], 1.09 [95% CI, 0.62-1.93]; P = .99), methotrexate (RR, 0.98 [95% CI, 0.78-1.23]; P = .83), cyclosporine (RR, 1.16 [95% CI, 0.48-2.80]; P = .49), and biologic medications as a single agent (RR, 2.67 [95% CI, 0.69-10.3]; P = .14) was not associated with HZ. The use of combination treatment with biologic medications and methotrexate was significantly associated with an increased incidence of HZ (RR, 1.66 [95% CI, 1.08-2.57]; P = .02). The use of acitritin was associated with decreased incidence of HZ (RR, 0.69 [95% CI, 0.49-0.97]; P = .004).

Conclusions and Relevance:  
Physicians may need to consider offering an HZ preventive vaccine to patients receiving combination treatment with biologic medications and methotrexate, particularly if they have additional risk factors for HZ.

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[mataribot]

Only anti TNFs require MTX, others biological may not need MTX. There was a study that showed MTX reduces drug antibodies associate with anti TNFs. However, there isn't any correlation (posative) that shows that MTX prevents the drug from failing. However, drug antibodies are associated with side effects, but there isn't any evidence to show that MTX reduces side effects of anti tnfs

[Caroline]

Only anti TNFs require MTX, others biological may not need MTX. There was a study that showed MTX reduces drug antibodies associate with anti TNFs. However, there isn't any correlation (posative) that shows that MTX prevents the drug from failing. However, drug antibodies are associated with side effects, but there isn't any evidence to show that MTX reduces side effects of anti tnfs

Do I read out of that, that it is basically useless to combine the therapies? That's very important to know.

[mataribot]

No, there isn't enough studies done to show that MTX doesn't help anti tnfs. All we know for sure is that it reduces anti tnfs drug antibodies. There needs to be studies done to determine if reduces SEs of anti tnfs and if it increases longevity of the drugs.

My personal guess is it doesn't... But that needs to be proven