Friday, 18 Oct 2019

You are here

Shingles Vaccine Studies in A&R

The current issue of Arthritis & Rheumatology features an editorial and two novel articles on the herpes zoster vaccine. Kevin Winthrop and colleagues report on the results of a phase II trial wherein 112 patients about to begin tofacitinib therapy were vaccinated with the live-virus zoster vaccine (LZV). They found that starting tofacitinib 2-3 weeks after LZV resulted in normal VZV-specific humoral and cell-mediated immune responses to LZV compared with placebo-treated patients. The only downside was the one patient who lacked pre-existing VZV immunity and developed cutaneous vaccine dissemination two days after starting tofacitinib (16 days post-vaccination). (Citation source https://buff.ly/2iGuLwr)

A second study from Drs. Winthrop, Curtis, Lindsay et al. analyzed HZ events across 19 tofacitinib clinical trials (6,192 patients; 16,839 patient-years). The reported incidence rate (from  636 tofacitinib-treated patients) 4.0  per 100 patient-years (95% CI 3.7–4.4). Most were non-serious (93%) and involved 1 dermatome (94%) and varied widely by region with higher rates in Eastern Europe, Japan and Korea. Glucocorticoids were shown to increase risk.  (Citation source https://buff.ly/2wgcD1o)

An editorial on HZ (written by yours truly) was entitled  "Herpes Zoster – Fear the Infection, Value the Solution", a quote attributed to Dr. William Schaffner from the 2015 ACR Annual meeting. Zoster will affect one-third of the population and moreso as we age. The editorial reviews those who are at risk, and when and how to properly use the current LZV vaccine. 

Those at risk include patients over age 60 years, those with chronic medical conditions (e.g., renal failure, diabetes mellitus, rheumatoid arthritis, chronic pulmonary disease), a prior history of shingles, chronic steroid use, current biologic use, use of Jak Inhibitors, those naive to the virus or patients with very immature, highly suppressed immune systems.

Disclosures: 
The author has received compensation as an advisor or consultant on this subject

Add new comment

More Like This

Joint Injections: Are They Worth the Risk?

Intra-articular injections of corticosteroids for relief of the pain of hip or knee osteoarthritis (OA) may have adverse long-term consequences, researchers suggested.

Hydroxychloroquine Blood Levels May Predict Future Retinopathy

A study of 527 patients receiving daily hydroxychloroquine (HCQ) concluded that hydroxychloroquine blood levels may predict future HCQ retinopathy.

This study assessed whether lower HCQ dosing, as recommended by the 2016 American Academy of Ophthalmology (AAO) guidelines (less than 5 mg/kg), would favorably affect retinopathy outcomes.

Arthritis Foundation Releases First CBD Guidance for Adults With Arthritis

As the leading organization for people with arthritis, the Arthritis Foundation has just released the first CBD guidance for adults with arthritis. CBD, or cannabidiol, a plant-based compound, has become popular among people with arthritis seeking to ease chronic joint pain.

Persistent Inflammatory Arthritis After Immune Checkpoint Inhibitors

Braaten and colleagues from Johns Hopkins School of Medicine have reported their experience with chronic inflammatory arthritis induced by immune checkpoint inhibitor therapies, showing that in some, inflammatory arthritis persists after the immunotherapy has been discontinued.

Checkpoint Inhibitors: Who Gets Myocarditis?

The usual risk factors for myocarditis may not apply to who gets it while on immune checkpoint inhibiting cancer drugs, an FDA adverse event database suggested.