ACR 2019 | Daily Highlights

Herpes zoster vaccine

SAFETY AND HUMORAL IMMUNOGENICITY TO HERPES ZOSTER VACCINE IN PATIENTS WITH RHEUMATOID ARTHRITIS (INTERIM ANALYSIS)

Abstract: 1800
Authors: Ori Elkayam et al.

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Key content:
In this prospective multicenter study 132 RA patients, candidates to receive biologics or tofacitinib, under an immunosuppressive therapy with conventional DMARDs and/or glucocorticoids were vaccinated with a live attenuated HZ vaccine (Zostavax®) and compared with 35 healthy controls (HC). All subjects were above the age of 50 years and received clinical and laboratory assessments at baseline and after 6 weeks.

Whereas in the HC group only local reactions at the injection site occurred 11 of the 132 RA patients had systemic reactions such as fever, 2 had mild rash and one herpes zoster. 7 reported worsening of RA. The DAS did not change at 6 weeks. The antibody titre increased significantly in both groups. The degree of humoral response was similar in the 2 groups.

Relevance:
In RA patients treated with conventional DMARDs (not specified which DMARDs were used in the vaccinated population) vaccination with a live attenuated vaccine against herpes zoster was safe and induced an adequate booster response.

There were no severe side effects but more systemic reactions like fever or rash and 1 patient had a herpes zoster after vaccination.

Since the risk of herpes zoster is increased in RA patients treated with JAK inhibitors (Tofacintinib, Baricitinib) zoster vaccination is recommended before starting these drugs. Since the recombinant inactivated vaccine Shingrix® is not yet approved in Switzerland we can use Zostavax or import Shingrix from Germany or France where it’s approved and available. Unfortunately both vaccines are not covered by the health insurance.

Zusammenfassung und Kommentar von:
Dr. Thomas Langenegger
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