Immune suppressed patients should be offered shingles vax

4 minute read

The Shingrix vaccine can provide immunity to patients with rheumatic diseases on immunosuppressive treatment, researchers say.

Patients with rheumatic diseases on immunosuppressive treatment can reach a protective level of immunity to the herpes zoster virus with the Shingrix vaccine, a small study has found.

Presenting a poster to ACR 2022, lead author and New York rheumatologist Dr Alina Kifayat said the results supported the need to offer the vaccine to this group of patients.

“As rheumatologists we deal with patients who are very susceptible to infections and herpes zoster is one of those common infections that we do need to watch out for,” she said.

“Vaccination is an important part of our practice and it helps. It helps us protect our patients from several preventable infections and with the advent of the recombinant inactive Shingrix vaccine it added an additional tool in our box to be able to help protect our patients.”

While the research did find that patients had an immune response, the increase in antibodies was lower than in those patients in the control group.

And leading Australian infectious diseases physician Professor Paul Griffin told Rheumatology Republic this highlighted the importance of vaccination as soon as possible after diagnosis.

“The ideal time to look at vaccines like this is before patients embark on this [immunosuppressive] therapy if you have that opportunity,” he said.

“If we can get people vaccinated at the first stage, when they’re contemplating starting significant immunosuppressive therapy, those people can hopefully get a better response to this vaccine as well.”

As part of their study for the ACR poster presentation, researchers enrolled 29 patients, including six who were part of the control group.
Patients were all aged over 50 years, with autoimmune conditions including rheumatoid arthritis (RA), psoriatic arthritis (PsA) and systemic lupus erythematosus (SLE), and who were being treated with bDMARDs, cDMARDs or tsDMARDs, and with or without steroids.

The control group comprised patients aged over 50 years without autoimmune diseases and not on immunosuppressive medications.

After pre-vaccination serum antibody quantification, patients received two series of IM Shingrix vaccine (0.5mL each) administered two to six months apart.

Repeat bloodwork was performed 6-12 weeks after the second dose to assess post-vaccination antibody response.

Overall, antibody titre response of control group patients was at least three times higher compared to patients with rheumatic diseases.

“Using a protective level of antibody titers at 150U/ml, most rheumatic disease patients (91%) did reach a protective level of immunity supporting the need to offer Shingrix vaccination to our patients,” the authors wrote.

“The vaccine was well tolerated with no major adverse events.”

Professor Griffin said patients were not usually started on the most potent immunosuppression treatments at the outset from diagnosis, so there was time to accommodate the two doses of Shingrix.

“We know that shingles in this group of patients is not ideal and that their risk is significantly increased by this very therapy,” he said.

“It’s important to have those conversations with your patients at the first opportunity and hopefully that way we can have a whole lot of things on board including other appropriate vaccines and even education about other infection risks.”

Earlier this year, the TGA approved Shingrix for immunocompromised patients aged over 18 years who are at increased risk of shingles.

This built on Shingrix’s existing approval for Australian adults aged 50 years and over for the prevention of shingles (herpes zoster) and post-herpetic neuralgia (PHN).
The TGA approval now applies to in people aged 18 years and over who are at increased risk of shingles, including those who are immune deficient or immunosuppressed, due to a disease and/or therapy, may be at increased risk of shingles. 

The vaccine is not subsidised and will cost patients up to $600. Patients with private health insurance may be eligible for a rebate.
Shingrix’s manufacturer GSK Australia applied to PBAC for the vaccine to be listed on National Immunisation Program in 2018 but was unsuccessful. A GSK spokesperson told Rheumatology Republic in March that the company had not ruled out making another application.

“We believe there is strong evidence underpinning the community health benefits of wider access to Shingrix,” the spokesperson said.

“We note that other comparable countries have been able to provide subsidised access to Shingrix and we hope that Australia can avoid being left behind in the future. 

“Until that time, we are glad to be able to provide some access in the private market now so that some Australians can begin to benefit now without further delay.”

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