DMARDs and Herpes Zoster Vaccination: To Stop or Not To Stop Save
Dr. Jonathan Kay discusses abstracts POS0620 and OP0020 presented at Eular 2024 in Vienna, Austria.
Transcription
Hello. I'm Jonathan Kaye reporting from EULAR twenty twenty four in Vienna. Yesterday, Kevin Winthrop from Oregon Health Sciences University presented two very interesting papers, both about immunization with herpes zoster vaccine in patients treated with various biologics or targeted synthetic DMARDs. He presented one paper about patients who were on upadacitinib in the SELECT COMPARE study who were immunized with a dose of recombinant herpes zoster vaccine at baseline and another at eight weeks after that first dose. The patients who continued to take both upadacitinib and methotrexate developed both humoral immunity and cell mediated immunity to herpes zoster virus.
In contrast, patients in another study that he has been conducting who were taking abetacept either intravenously or subcutaneously were immunized with a similar schedule to receive either the recombinant herpes zoster vaccine or placebo at baseline and then eight weeks later. And in contrast to the patients continuing upadacitinib, there was humoral immunity in about two thirds of the patients receiving abatacept, but no cell mediated immunity. This study is ongoing but suggests that abatacept should be stopped perhaps two weeks or even four weeks before vaccination. However, the exact timeframe with which to stop abatacept before zoster vaccination has not been established. On the other hand, patients receiving upadacitinib and probably other targeted synthetic DMARDs, JAK inhibitors, can continue taking the JAK inhibitor and methotrexate without stopping and still develop immunity to herpes zoster vaccination.
These studies are important because patients on JAK inhibitors are at increased risk of developing herpes zoster. And it's very important to immunize these patients ideally before beginning a JAK inhibitor. But certainly, if they're started on the JAK inhibitor, herpes zoster vaccination should be performed as soon as possible. For more about this and other studies from EULAR twenty twenty four in Vienna, go to roomnow.com. I'm Jonathan Kaye, and I look forward to seeing you again soon.
In contrast, patients in another study that he has been conducting who were taking abetacept either intravenously or subcutaneously were immunized with a similar schedule to receive either the recombinant herpes zoster vaccine or placebo at baseline and then eight weeks later. And in contrast to the patients continuing upadacitinib, there was humoral immunity in about two thirds of the patients receiving abatacept, but no cell mediated immunity. This study is ongoing but suggests that abatacept should be stopped perhaps two weeks or even four weeks before vaccination. However, the exact timeframe with which to stop abatacept before zoster vaccination has not been established. On the other hand, patients receiving upadacitinib and probably other targeted synthetic DMARDs, JAK inhibitors, can continue taking the JAK inhibitor and methotrexate without stopping and still develop immunity to herpes zoster vaccination.
These studies are important because patients on JAK inhibitors are at increased risk of developing herpes zoster. And it's very important to immunize these patients ideally before beginning a JAK inhibitor. But certainly, if they're started on the JAK inhibitor, herpes zoster vaccination should be performed as soon as possible. For more about this and other studies from EULAR twenty twenty four in Vienna, go to roomnow.com. I'm Jonathan Kaye, and I look forward to seeing you again soon.
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