{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T14:47:34Z","timestamp":1790606854297,"version":"4.1.0"},"reference-count":12,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2019,7,29]],"date-time":"2019-07-29T00:00:00Z","timestamp":1564358400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006093","name":"Patient-Centered Outcomes Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006093","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care & Research"],"published-print":{"date-parts":[[2019,9]]},"abstract":"Objective<\/jats:title>Increased incidence of herpes zoster (HZ<\/jats:styled-content>) has been observed with JAK<\/jats:styled-content> inhibitors such as tofacitinib. However, whether concomitant methotrexate (MTX<\/jats:styled-content>) and\/or glucocorticoids confer additional (additive or multiplicative) risk is unclear. We evaluated HZ<\/jats:styled-content> risk in tofacitinib users with and without MTX<\/jats:styled-content> and glucocorticoids.<\/jats:p><\/jats:sec>Methods<\/jats:title>Within MarketScan and Medicare data (2011\u20132016), we identified all patients with rheumatologist\u2010diagnosed rheumatoid arthritis initiating treatment with tofacitinib (index date); demographics and baseline covariates were evaluated in the year prior to the index date. HZ<\/jats:styled-content> was ascertained using International Classification of Diseases, Ninth Revision or Tenth Revision codes with antiviral drug use (\u00b17 days). Multivariable Cox regression was used to evaluate hazard ratios (HR<\/jats:styled-content>s) for HZ<\/jats:styled-content> in tofacitinib users with and without current concomitant MTX<\/jats:styled-content> and glucocorticoids, controlling for baseline covariates.<\/jats:p><\/jats:sec>Results<\/jats:title>We studied 8,030 new tofacitinib users (83.3% women). The mean \u00b1 SD<\/jats:styled-content> age was 60.3 \u00b1 12.6 years. HZ<\/jats:styled-content> incidence in tofacitinib users was numerically lowest in the absence of glucocorticoids (3.4 per 100 patient\u2010years with MTX<\/jats:styled-content>; 3.7 per 100 patient\u2010years without MTX<\/jats:styled-content>). An approximately 2\u2010fold increased incidence of HZ<\/jats:styled-content> was observed for tofacitinib users receiving either glucocorticoids alone (6.0 per 100 patient\u2010years) or both MTX<\/jats:styled-content> plus glucocorticoids (6.5 per 100 patient\u2010years). The adjusted HR<\/jats:styled-content> for HZ<\/jats:styled-content> in tofacitinib users was unchanged (HR<\/jats:styled-content> 0.99 [95% confidence interval (95% CI<\/jats:styled-content>) 0.64\u20131.54]) when given only with MTX<\/jats:styled-content>, but was increased (HR<\/jats:styled-content> 1.96 [95% CI<\/jats:styled-content> 1.33\u20132.88]) for tofacitinib plus glucocorticoids. Older age and female sex were also risk factors, while prior vaccination was associated with a strong trend for lower risk.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>In tofacitinib users, HZ<\/jats:styled-content> occurred at a rate of approximately 4% per year and was further doubled with glucocorticoid exposure. Concomitant MTX<\/jats:styled-content> did not confer additional risk. Zoster vaccination may decrease risk.<\/jats:p><\/jats:sec>","DOI":"10.1002\/acr.23769","type":"journal-article","created":{"date-parts":[[2018,10,8]],"date-time":"2018-10-08T05:51:25Z","timestamp":1538977885000},"page":"1249-1254","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":79,"title":["Risk for Herpes Zoster in Tofacitinib\u2010Treated Rheumatoid Arthritis Patients With and Without Concomitant Methotrexate and Glucocorticoids"],"prefix":"10.1002","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8907-8976","authenticated-orcid":false,"given":"Jeffrey R.","family":"Curtis","sequence":"first","affiliation":[{"name":"University of Alabama Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fenglong","family":"Xie","sequence":"additional","affiliation":[{"name":"University of Alabama Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuo","family":"Yang","sequence":"additional","affiliation":[{"name":"University of Alabama Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasha","family":"Bernatsky","sequence":"additional","affiliation":[{"name":"McGill University Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lang","family":"Chen","sequence":"additional","affiliation":[{"name":"University of Alabama Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huifeng","family":"Yun","sequence":"additional","affiliation":[{"name":"University of Alabama Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Winthrop","sequence":"additional","affiliation":[{"name":"Oregon Health Sciences University Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,7,29]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.33383"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.38745"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209131"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.40189"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/art.40187"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/14760584.2017.1395703"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwx245"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22470"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.146"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22628"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/EDE.0b013e3181a819a1"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.7304"}],"container-title":["Arthritis Care & Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Facr.23769","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.23769","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/acr.23769","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/acr.23769","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T15:25:44Z","timestamp":1759418744000},"score":1,"resource":{"primary":{"URL":"https:\/\/acrjournals.onlinelibrary.wiley.com\/doi\/10.1002\/acr.23769"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,7,29]]},"references-count":12,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2019,9]]}},"alternative-id":["10.1002\/acr.23769"],"URL":"https:\/\/doi.org\/10.1002\/acr.23769","archive":["Portico"],"relation":{},"ISSN":["2151-464X","2151-4658"],"issn-type":[{"value":"2151-464X","type":"print"},{"value":"2151-4658","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,7,29]]},"assertion":[{"value":"2018-07-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2018-10-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-07-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}