Neutrophil-lymphocyte ratio: an independent predictor of the herpes zoster risk in rheumatoid arthritis patients treated with tofacitinib

Abstract To investigate the role of the neutrophil-lymphocyte ratio (NLR) in the risk of developing herpes zoster (HZ) in patients with rheumatoid arthritis (RA) receiving tofacitinib. This was a prospective observational study recruiting patients who were diagnosed with RA and treated with tofacitinib. Patients with previous herpes zoster infections were excluded from this study. All patients were assessed for HZ every 1–3 months and were followed up for 12 months. Univariate and multivariate logistic regression analyses were used to assess the relationship between NLR and HZ. A cutoff value of NLR was determined based on an ROC curve. A total of 277 patients were included in this study, 19 of whom developed herpes zoster. Univariate and multivariate logistic regression analyses showed that NLR (OR=19.813, p<0.05), neutrophils (OR=15.521, p<0.05) and lymphocytes (OR=0.001, p<0.05) were independent influencing factors of HZ. Through the analysis of the ROC curve, it was found that neutrophils, lymphocytes and NLR had a high predictive value for HZ (AUC=0.75; AUC=0.76; AUC=0.94). The cutoff values were 4.46*10^9/L, 1.70*10^9/L and 3.24, respectively. Given that the NLR is easy to test, NLR was also expected to be a very promising quantitative biomarker for predicting the risk of developing herpes zoster in patients with RA receiving tofacitinib.