Shingles Vaccine Studies in A&R Save

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.