Ustekinumab and herpes zoster

Abstract

Background: TNF-α antagonists may increase the risk of herpes zoster (HZ), as well as the duration and severity. Recently, the monoclonal antibody ustekinumab, blocking the p40 subunit of IL-12 and IL-23, has been introduced for treating moderate to severe plaque psoriasis. There are no PubMed reports of HZ occurring in people receiving ustekinumab treatment. Common HZ was reported in clinical trials.

Observation: Two patients with severe psoriasis treated with ustekinumab developed severe contiguous multidermatomal HZ 1 and 9 months after treatment initiation.

Discussion: The occurrence of HZ after the instauration of ustekinumab suggests a causal relationship. Indeed, the inhibition of the p40 subunit of IL-12 shifts the immune response towards a Th1 profile with diminished IFN-γ and TNF-α expression, decreasing the antiviral immune response.

Conclusion: Ustekinumab is probably a risk factor for developing HZ. Anti-HZ vaccination prior to ustekinumab treatment should be considered.