Is the Shingles Vaccine Safe in Patients with RA?

The live zoster vaccine (LZV) is safe and effective for most patients age 50 years or older who have rheumatoid arthritis (RA), according to a recent study. However, the vaccine may not be safe for those without preexisting varicella zoster virus (VZV) immunity.

The risk for herpes zoster is higher in patients with RA. Vaccination for herpes zoster is recommended for RA patients age 50 years or older prior to initiating treatment with biologic agents or tofacitinib.
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For their study (Arthritis Rheumatol. doi:10.1002/art.40187), the researchers evaluated 112 patients age 50 years or older with active RA who had been receiving background methotrexate. Patients were administered LZV and were randomly assigned to receive either 5 mg tofacitinib twice daily (n = 55) or placebo 2 to 3 weeks following vaccination (n = 57).

Humoral responses and cell-mediated responses were measured at baseline and 2, 6, and 14 weeks following vaccination. The primary outcome was the geometric mean fold rise (GMFR) in VZV-specific immunoglobulin G (IgG) levels. Other outcomes included T cells, or the number of spot-forming cells/10⁶ peripheral blood mononuclear cells, at 6 weeks following vaccination.

Results indicated that the GMFR in VZV-specific IgG levels was 2.11 in patients taking tofacitinib and 1.74 in patients taking placebo at 6 weeks following vaccination. The VZV-specific T cell GMFR had been similar in those on tofacitinib (1.50) and those on placebo (1.29).

The researchers noted that 3 (5.5%) patients on tofacitinib and 0 (0.0%) patients on placebo experienced serious adverse events. Additionally, 1 patient without preexisting VZV immunity had developed cutaneous vaccine dissemination at day 2 following tofacitinib initiation (day 16 post-vaccination). However, this resolved after the discontinuation of tofacitinib and the administration of antiviral treatment.

“Patients who began treatment with tofacitinib 2-3 weeks after receiving LZV had VZV-specific humoral and cell-mediated immune responses to LZV similar to those in placebo-treated patients,” the researchers concluded. “Vaccination appeared to be safe in all of the patients except 1 patient who lacked preexisting VZV immunity.”

—Christina Vogt

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