Herpes zoster vaccine may be used in RA patients receiving cDMARD, low-dose GC
A recent study has shown that the herpes zoster (HZ) vaccine induces varicella zoster virus (VZV)-specific cellular and humoral responses in patients with rheumatic arthritis (RA).
Additionally, the vaccine-induced VZV-specific cellular immune response is weaker in patients with RA than in those with osteoarthritis (OA), but the vaccine may still be considered in RA patients receiving conventional disease-modifying antirheumatic drugs (cDMARD) and/or low-dose glucocorticoids (GC).
None of the patients developed vaccination-induced HZ during follow-up (median, 1.6 years). The VZV-specific enzyme-linked immunospot spot-forming units and anti-VZV immunoglobulin G antibodies significantly increased in patients with RA and OA who received the HZ vaccine. Patients with RA had lower spot-forming units than those with OA both at baseline and at 12 weeks after vaccination.
The disease activity index for patients with RA was similar at baseline and at 12 weeks post-HZ vaccination. However, flare developed in six patients with RA during the 12 weeks. A total of 17 (24.6 percent) participants reported a mild adverse event, such as an injection site reaction (11.6 percent).
This observational study of a live attenuated HZ vaccine included 41 patients with RA receiving cDMARD and/or low-dose GC and 28 patients with OA. Blood samples were taken before and at 12 weeks post-HZ vaccination.
The authors assessed immunogenicity using VZV-specific interferon gamma ELISA and an in-house ELISA. They analysed clinical outcomes, including adverse events, HZ occurrence and RA flares.
A recent study by Gagliardi ang colleagues showed that HZ vaccine was well-tolerated and effective in preventing HZ disease, with protection lasting for 3 years. [Cochrane Database Syst Rev 2016;3;3:CD008858]