Herpes Zoster Risk with Skyrizi

Comparison with Other Biologics

JAK inhibitors demonstrate incidence rates of 3-4 per 100 patient-years in Western populations and up to 9 per 100 patient-years in Japan and Korea, compared to 2-3 per 100 patient-years for TNF inhibitors, according to the European League Against Rheumatism 1, 2, 3
TNF inhibitors show increased herpes zoster risk with registry data indicating elevated rates compared to conventional DMARDs, as reported by the British Society for Rheumatology 4

If herpes zoster develops during Skyrizi treatment, initiate antiviral therapy promptly with acyclovir, valacyclovir, or famciclovir, as recommended by the American Academy of Dermatology 5
Consider temporarily holding Skyrizi until the infection resolves, though this is not explicitly mandated in the label, according to the American Academy of Dermatology 5
Monitor for complete healing before resuming therapy, as advised by the American Academy of Dermatology 5

The recombinant zoster vaccine should be considered before initiating Skyrizi therapy, reducing herpes zoster risk by approximately 81% across immunocompromised populations, as recommended by the Centers for Disease Control and Prevention 6

Higher risk patients include those over age 65 years, patients receiving concomitant glucocorticoids ≥7.5 mg/day, female patients, and Asian populations, particularly Japanese and Korean patients, as identified by the European League Against Rheumatism 1, 2, 3