Thursday, 16 Aug 2018

You are here

CDC Endorses New Shingles Vaccine Over Zostavax

The  U.S. Centers for Disease Control (CDC) announced on 25 October they endorsed the use of the new GSK shingles vaccine (Shingrix) over the currently available live-virus vaccine (Zostavax) from Merck. 

The new Herpes Zoster subunit vaccine (Shingrix) is recommended for the prevention of herpes zoster and related complications for immunocompetent adults aged 50 years and older. It is also recommended for the prevention of herpes zoster and related complications for immunocompetent adults who previously received Zoster Vaccine Live (Zostavax).

Shingles affects 1 in 3 Americans in their lifetime, and strikes an estimated 1 million Americans each year.

The ACIP has voted in favor (8-7) for the preferred use of Shingrix over Zostavax and its recommendations will be forwarded to the director of the CDC and the US Department of Health and Human Services for review and approval. Once approved, the final recommendations will be published in a future Morbidity and Mortality Weekly Report (MMWR). It will take several months for the CDC to formally adopt the advisory panel’s recommendations.

The new recommendations mean up to 62 million more adults in the US should be immunized, approximately 42 million aged 50-59 years old and 20 million who have previously been vaccinated against shingles.[i]

 Approval of Shingrix was based on a comprehensive Phase III clinical trial program involving 38,000 adults to evaluate the vaccine’s efficacy, safety and immunogenicity. In a pooled analysis of these studies, Shingrix demonstrated efficacy against shingles greater than 90% across all age groups, as well as sustained efficacy over a follow-up period of 4 years.[v],[vi] By preventing shingles, Shingrix also reduced the overall incidence of postherpetic neuralgia (PHN), a form of chronic nerve pain lasting from at least three months up to several years and the most common complication associated with shingles.1

The most common side effects of Shingrix are pain, redness, and swelling at the injection site, muscle pain, tiredness, headache, shivering, fever, and upset stomach, which are related to the immune system responding to the vaccine. Based on available data, the majority of reactions to the vaccine were transient and mild to moderate in intensity, lasting less than three days. 

Add new comment

More Like This

Hydroxychloroquine Being Over-Dosed with New Guidelines?

Hydroxychloroquine retinopathy prevention guidelines have revised from ideal body weight-based dosing to actual body weight-based dosing; the question remains whether these have been adopted in clinical practice. A database of nearly 21,000 new HCQ users from a UK general population database studied HCQ dosing and use between 2007 and 2016. Specifically they examined whether users were subjected to excess HCQ dosing per ophthalmology guidelines (defined by exceeding 6.5 mg/kg of IBW and 5.0 mg/kg of ABW).

NSAID Use Around Conception Increases Miscarriage Risk

A study from the American Journal of Obstetrics & Gynecology analyzed pregnant women from the Kaiser Permanente healthcare system and compared newly pregnant women who took non-steroidal anti-inflammatory drugs or acetaminophen or neither showed that using NSAIDs around conception carried a more than four-fold higher risk of early miscarriage. (Citation source: http://bit.ly/2tqNWN6)

Could Measuring Drug Levels with TNF Treatment Hurt Your Patients?

Our colleagues in gastroenterology measure drug levels with certain biologics used in inflammatory bowel disease in order to increase the dose for optimal benefit if the patient has a low trough level (i.e. targeting drug level).

There have been GI trials with T2T with drug levels but they are not always suggesting that the strategy is superior to usual care. Also, this is really not a common practice in rheumatology.

Methotrexate Update

I was delighted to see that investigators presenting work at EULAR 2018 haven’t lost interest in our old friend methotrexate, with a number of abstracts examining issues of safety, dose and route of administration.

Low incidence of methotrexate induced liver abnormalities

Cancer Therapies Inducing Immune-Related Adverse Events (irAEs)

Recent shifts in the cancer treatment paradigm towards immune therapies has led to wide implementation of the novel immune check point inhibitors (ICI) in the treatment of multiple types of advanced cancer.

While being quite effective in oncology, these checkpoint inhibitors have led to the emergence of a quite unique spectrum of rheumatologic conditions presented under the umbrella of immune-related adverse events (irAEs).