Patients with rheumatoid arthritis face an increased risk of herpes zoster, but new research indicates that the live varicella-zoster vaccine can effectively prevent shingles in these patients before they start treatment with the drug tofacitinib.
Patients who live with rheumatoid arthritis are at increased risk for shingles compared with healthy adults, and disease-modifying antirheumatic drugs (DMARDs) used to treat rheumatoid arthritis are thought to increase this risk. Tofacitinib, a Janus kinase (JAK) inhibitor, is a targeted, synthetic DMARD approved for treatment of moderate to severely active rheumatoid arthritis in patients who have had an inadequate response to methotrexate.
A team of researchers led by Kevin Winthrop MD, MPH, of the Oregon Health and Science University conducted 2 studies to evaluate the effect of tofacitinib on the immune response and the safety of the live varicella-zoster vaccine. They found that the varicella-zoster vaccine elicits a robust immune response in patients when administered several weeks prior to the start of tofacitinib.
The researchers recently published their findings in Arthritis & Rheumatology.
The first study
This first study was a phase II trial of 112 patients older than 50 years with active rheumatoid arthritis receiving background methotrexate. All 112 patients were vaccinated with the live varicella-zoster vaccine; 2 to 3 weeks later, the participants were randomized to receive tofacitinib or placebo.
The start of tofacitinib after vaccination had no negative impact on the established immune response. Patients developed robust immune responses to the vaccine, and patients treated with tofacitinib had similar or even higher immune responses to the vaccine compared with placebo-treated patients. This result may have been the result of patients who received tofacitinib having better control of their rheumatoid arthritis than patients treated with placebo.
“We showed that the vaccine was adequately immunogenic in patients whether they were starting tofacitinib or placebo in a few weeks, and the immunogenicity and the response to the vaccine were similar to what we’ve seen outside the rheumatoid arthritis setting in general population studies,” said Dr Winthrop in a press release.
These studies were sponsored by Pfizer.
Winthrop KL, Wouters AG, Choy EH, et al. “The Safety and Immunogenicity of Live Zoster Vaccination in Patients With Rheumatoid Arthritis Before Starting Tofacitinib: A Randomized Phase II Trial.” Arthritis Rheumatol. 2017 Aug 28. doi: 10.1002/art.40187. [Epub ahead of print] 2017 Aug 28. doi: 10.1002/art.40187. [Epub ahead of print]
Winthrop KL, Curtis JR, Lindsey S, et al. “Herpes Zoster and Tofacitinib: Clinical Outcomes and the Risk of Concomitant Therapy.” Arthritis Rheumatol. 2017 Aug 28. doi: 10.1002/art.40189. [Epub ahead of print]
Peters D. “Studies Reveal How Shingles Vaccine Should Be Used in Arthritis Patients.” Wiley Newsroom. Published online August 28, 2017.