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Advisor(s)
Abstract(s)
O vírus Varicela Zoster pertence à família dos Herpesviridae, tendo uma grande
prevalência na população mundial. Existem duas possíveis manifestações da infeção –
primária (ocorre mais na infância, sob a forma de varicela) ou secundária (denominada
zona, associada a idades mais avançadas e à utilização de fármacos imunomoduladores
entre outros). Qualquer declínio na imunidade pode resultar na reativação viral, que
ocorre pelo facto de o vírus permanecer latente no nervo trigémio e nos gânglios das
raízes dorsais.
Com esta revisão bibliográfica pretende-se averiguar os riscos associados ao uso
de alguns fármacos imunomoduladores, bem como explorar as opções de tratamento e
prevenção existentes.
Os estudos têm demonstrado um aumento significativo do risco de zona com a
utilização de fármacos imunomoduladores como os antagonistas do fator de necrose
tumoral, inibidores da Janus Associated Kinases ou os dirigidos às células B. Dos
referidos, os antagonistas do fator de necrose tumoral alfa são apontados como os
principais responsáveis pela reativação do vírus Varicela Zoster. Dentro dessa classe, o
fármaco de maior risco parece ser o infliximab, independente da doença em que é
utilizado. Para além dos fármacos imunomoduladores, a corticoterapia, a idade avançada
e ser do sexo feminino também parecem contribuir para um aumento desse risco de
reativação. No caso particular do uso de corticoides, o aumento de risco ocorre quer de
modo isolado quer na associação com o uso concomitante de imunomoduladores. Nem
sempre é possível quantificar adequadamente esse risco dado o uso associado de outros
fármacos.
Atendendo à doença de base para a qual são utilizados estes fármacos, as medidas
a tomar podem ser distintas. Na maioria das vezes, é necessária a suspensão do fármaco
até resolução do quadro de herpes Zoster, sendo posteriormente reintroduzido. O
conhecimento em relação ao impacto destes fármacos ainda é limitado, pelo que é
necessário promover novos estudos para melhor conhecimento destes quadros. Mais
ainda, a aposta na vacinação é essencial para reduzir o risco e prevenir as complicações
associadas à reativação, nomeadamente a nevralgia pós herpética.
Varicella Zoster virus belongs to the Herpesviridae family, having a high prevalence in the world population. There are two possible manifestations of the infection - primary (which occurs more in childhood, in the form of chickenpox) or secondary (called shingles, associated with older ages and the use of immunomodulatory drugs, among others). Any decline in immunity can result in viral reactivation, which occurs as the virus remains latent in the trigeminal nerve and dorsal root ganglia. Throughout this literature review, we sought to investigate the risks associated with the use of some immunomodulatory drugs, as well as the existing treatment and prevention options. There is a significantly increased risk of developing herpes zoster with the use of tumor necrosis factor antagonist monoclonal antibodies, drugs that target B cells, and Janus kinase inhibitors. Tumor necrosis factor alpha antagonists are pointed out throughout this study as being largely responsible for Varicella Zoster virus reactivation. Of this class, the drug with the highest risk appears to be infliximab, regardless of the disease in which it is used. In addition, factors such as older age, female gender and use of corticosteroids were associated with a higher risk of reactivation. Corticosteroid therapy is directly associated with an increased risk of Varicella Zoster virus reactivation, either alone or in association with other immunomodulators. It is not always possible to adequately quantify this risk given the cumulative use of other drugs. Given the underlying disease for which these drugs are used, the measures to be taken can be different. In most cases, it is necessary to suspend the drug until the herpes zoster is resolved, and reintroduce it afterwards. Knowledge about the impact of these drugs is still limited, so it is necessary to promote further studies in order to better understand these conditions. Furthermore, the commitment to vaccination is essential to reduce the risk and prevent complications associated with reactivation, namely postherpetic neuralgia.
Varicella Zoster virus belongs to the Herpesviridae family, having a high prevalence in the world population. There are two possible manifestations of the infection - primary (which occurs more in childhood, in the form of chickenpox) or secondary (called shingles, associated with older ages and the use of immunomodulatory drugs, among others). Any decline in immunity can result in viral reactivation, which occurs as the virus remains latent in the trigeminal nerve and dorsal root ganglia. Throughout this literature review, we sought to investigate the risks associated with the use of some immunomodulatory drugs, as well as the existing treatment and prevention options. There is a significantly increased risk of developing herpes zoster with the use of tumor necrosis factor antagonist monoclonal antibodies, drugs that target B cells, and Janus kinase inhibitors. Tumor necrosis factor alpha antagonists are pointed out throughout this study as being largely responsible for Varicella Zoster virus reactivation. Of this class, the drug with the highest risk appears to be infliximab, regardless of the disease in which it is used. In addition, factors such as older age, female gender and use of corticosteroids were associated with a higher risk of reactivation. Corticosteroid therapy is directly associated with an increased risk of Varicella Zoster virus reactivation, either alone or in association with other immunomodulators. It is not always possible to adequately quantify this risk given the cumulative use of other drugs. Given the underlying disease for which these drugs are used, the measures to be taken can be different. In most cases, it is necessary to suspend the drug until the herpes zoster is resolved, and reintroduce it afterwards. Knowledge about the impact of these drugs is still limited, so it is necessary to promote further studies in order to better understand these conditions. Furthermore, the commitment to vaccination is essential to reduce the risk and prevent complications associated with reactivation, namely postherpetic neuralgia.
Description
Keywords
Herpes Zoster Imunomodulação Imunossupressão Tratamento Antivírico Vacinação