Does Stelara Increase Shingles Risk?
Stelara (ustekinumab), a biologic used for psoriasis, Crohn's disease, and ulcerative colitis, suppresses parts of the immune system by blocking IL-12 and IL-23 cytokines. This can raise the risk of infections, including reactivation of varicella-zoster virus (VZV), which causes shingles (herpes zoster).[1][2]
Clinical trials and post-marketing data show shingles occurs more often in Stelara users than in the general population. In psoriasis trials, herpes zoster rates were 2.8-3.1 cases per 100 patient-years on Stelara, versus 1.6-2.0 on placebo. Pooled ulcerative colitis trials reported 1.7% incidence.[2][3]
How Common Is Shingles on Stelara?
Real-world evidence confirms elevated risk:
- A 2023 study of over 100,000 psoriasis patients found Stelara users had 1.5-2 times higher shingles odds than those on non-biologic therapies.[4]
- FDA labeling lists herpes zoster as a warning, with rates up to 4% in some Crohn's trials.[2]
Age over 50, prior immunosuppression, or comorbidities amplify risk.[1][3]
Shingles Symptoms and What to Watch For
Patients report painful rash, blisters, fever, and nerve pain (postherpetic neuralgia in 10-20% of cases). On Stelara, outbreaks can be severe or disseminated due to weakened immunity.[2][5] Report symptoms immediately—early antivirals like valacyclovir reduce complications.[1]
Prevention Options for Stelara Patients
- Shingrix vaccine: CDC recommends two doses for adults 19+ on immunosuppressants like Stelara, ideally before starting (95% effective).[1][6] Administer 2-6 months apart; live vaccines like Zostavax are contraindicated.[2]
- Hold Stelara during active shingles; resume after resolution.[3]
- Prophylactic antivirals considered for high-risk patients.[5]
Compared to Other Biologics
Stelara's shingles risk is moderate:
| Drug | Herpes Zoster Rate (per 100 patient-years) |
|------|--------------------------------------------|
| Stelara | 2-3[2] |
| Humira (adalimumab) | 3-5[7] |
| Skyrizi (risankizumab) | 1-2[8] |
| Cosentyx (secukinumab) | 1-3[9] |
TNF inhibitors like Humira carry higher risk; IL-17/23 inhibitors like Stelara are lower but not zero.[4][7]
Patient Experiences and Next Steps
Forums like Drugs.com and Reddit note shingles hitting 3-12 months into Stelara, often resolving with treatment but causing treatment pauses. Consult your doctor about vaccination status and monitoring—risk drops post-Shingrix.[5][10]
Sources
[1]: CDC Shingles Vaccine Recommendations
[2]: Stelara Prescribing Information (Janssen)
[3]: FDA Stelara Label
[4]: JAMA Dermatology 2023 Study
[5]: Crohn's & Colitis Foundation
[6]: CDC ACIP Guidelines
[7]: Humira Label
[8]: Skyrizi Label
[9]: Cosentyx Label
[10]: Drugs.com Stelara Reviews