The vaccine is important for rheumatic patients, because the rate of shingles is markedly higher for those with lupus, inflammatory bowel disease, RA and psoriatic arthritis.
The ACR recommends the herpes zoster vaccine for those 50 and up, with methotrexate, prednisone and azathioprine not contraindicated, but with the contraindications of biologics and tofacitinib.
There is evidence that methotrexate ‘severely diminishes’ the response to Pneumovax ….
Dr. Winthrop suggested that among some patients, even earlier vaccination should be explored because—at least among lupus patients—people as young as 21 to 30 years old have been found to have higher incidence rates of herpes zoster.
“I do think it raises the question as to whether we should be vaccinating younger people with this vaccine in some of these disease groups, but that’s something that needs to be tested,” he said.
The safety and efficacy of Zostavax in RA is still being studied, including with a trial of patients on biologics and TNF-blockers that he is overseeing. He has reason to think the vaccines are likely safe, he said. Medicare data show that mistaken vaccinations in 550 of such patients produced no ill effects after about 40 days.
A herpes zoster vaccine that is not live is under development, he said, which could bring a valuable new option for physicians. But Dr. Winthrop added that it’s an adjuvenated vaccine with very high efficacy rates—up to 98%—and there is some concern that it may be too potent for patients with rheumatic diseases.
“I think it’s promising,” he said. “But I do worry that maybe it’s too adjuvenated. Maybe in your population, it will cause RA flares or PsA flares—I don’t know. We totally need to test it out in your group. And if it’s safe, then, boy, this is going to be a great thing for you. But we’ll just have to see.”
Thomas R. Collins is a freelance medical writer based in Florida.
References
- Winthrop KL, Silverfield J, Racewicz A, et al. The effect of tofacitinib on pneumococcal and influenza vaccine responses in rheumatoid arthritis. Ann Rheum Dis. 2016 Apr;75(4):687–695.
- Isturiz R, Webber C. Prevention of adult pneumococcal pneumonia with the 13-valent pneumococcal conjugate vaccine: CAPiTA, the community-acquired pneumonia immunization trial in adults. Hum Vaccin Immunother. 2015;11(7):1825–1827.
- DiazGranados CA, Dunning AJ, Kimmel M, et al. Efficacy of high-dose versus standard-dose influenza vaccine in older adults. N Engl J Med. 2014 Aug 14;371(7):635–645.
