Preventing Shingles in Patients with Rheumatoid Arthritis

Jennifer Barrett, Assistant Editor
Published Online: Friday, September 1st, 2017
The live varicella-zoster vaccine can effectively prevent shingles in rheumatoid arthritis patients starting treatment with the drug tofacitinib, according to results of 2 recently-published studies in Arthritis & Rheumatology.

Patients who received the shingles vaccine several weeks prior to the start of treatment for arthritis with tofacitinib demonstrated robust immune responses that were sustained even after the start of treatment.
The researchers conducted 2 studies to evaluate the effects of the shingles vaccine in patients with arthritis. In one study, 112 patients with active rheumatoid arthritis were vaccinated and then randomly assigned to receive either tofacitinib or a placebo, initiated 2-3 weeks after the vaccination.1 The researchers noted that patients treated with tofacitinib had similar or even higher immune responses to the vaccine compared with patients treated with placebo.
However, the only patient who did not have varicella in the past experienced disseminated varicella infection after starting tofacitinib. The researchers noted the importance of using the vaccine for patients who have have previously had varicella.  
In the second study, the researchers examined whether concomitant use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or corticosteroids increased the risk of shingles.2 The researchers analyzed 19 clinical trials involving 6192 patients with rheumatoid arthritis. Shingles rates were lowest in patients who were taking tofacitinib without csDMARDs and/or corticosteroids.
Overall, the researchers concluded that vaccinating patients with rheumatoid arthritis and eliminating corticosteroids and csDMARDs could help lower their shingles risk.
1.     Winthrop KL, Wouters A, Choy E, et al. The safety and immunogenicity of live zoster vaccination in rheumatoid arthritis patients before starting tofacitinib: a randomized phase 2 trial. Arthr Rheumatol. 2017. doi: 10.1002/art.40187
2.     Winthrop KL, Curtis JR, Lindsey S, et al. Herpes zoster and tofacitinib: clinical outcomes and the risk of concomitant therapy. Arthr Rheumatol. 2017. doi: 10.1002/art.40189

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