Live Varicella-Zoster Vaccines Safe for Patients Receiving TNF Inhibitors

Live virus vaccines are generally safe to administer to patients receiving tumor necrosis factor (TNF) inhibitors, according to a recent study funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the American College of Rheumatology, published in Annals of Internal Medicine.

To evaluate the safety and immunogenicity of the live attenuated zoster vaccine, the authors conducted a randomized, blinded, placebo-controlled trial. Patients who were aged 50 years or older and receiving a TNF inhibitor for dermatology, gastroenterology, and rheumatology indications were randomly assigned to receive either the vaccine or placebo. Assays of serum and peripheral blood mononuclear cells were evaluated at baseline and 6 weeks postvaccination, and suspected infection or herpes zoster disease was clinically assessed using photographs and polymerase chain reaction.

In total, 617 participants received either the vaccine (n=310) or placebo (n=307) between March 2015 and December 2018. Indications for TNF inhibitor included rheumatoid arthritis and psoriatic arthritis, and therapeutics included adalimumab, infliximab, etanercept, golimumab, and certolizumab. Methotrexate and oral glucocorticoids were sometimes used as concomitant therapies. 

After 6 weeks, no cases of confirmed varicella infection were found among the patient cohorts. 

While the authors noted the study is potentially limited in generalizability to other types of immunomodulators, this trial can be used to inform safety concerns related to live virus vaccines in patients receiving TNF-inhibiting biologics.

Reference
Curtis JR, Cofield SS, Bridges SL Jr, et al. The safety and immunologic effectiveness of the live varicella-zoster vaccine in patients receiving tumor necrosis factor inhibitor therapy: a randomized controlled trial. Ann Intern Med. Published online September 28, 2021. doi:10.7326/M20-6928