Effectiveness of recombinant zoster vaccine (RZV) in patients with inflammatory bowel disease

Kochhar, Gursimran; Desai, Aakash; Caldera, Freddy; Hachem, Sandra El; Aoun, Elie; Sandhu, Dalbir S.; Mohan, Babu P.; Dulai, Parambir S.; Farraye, Francis A.

doi:10.1016/j.vaccine.2021.05.043

Cited by 13 publications

(14 citation statements)

References 11 publications

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“…Specifically in IBD, the full dose of the recombinant vaccine has been shown to reduce occurrence of shingles significantly in patients with IBD >50 years, compared with unvaccinated individuals 56 . In another study in patients with IBD ≥50 years of age, the rate of Herpes zoster infection in vaccinated patients was significantly lower compared with the general population 57 . This study also demonstrated that unvaccinated patients with IBD were six times more likely to develop Herpes zoster infection than the general population.…”

Section: Discussionmentioning

confidence: 59%

Section: F I G U R Ementioning

confidence: 51%

“…56 In another study in patients with IBD ≥50 years of age, the rate of Herpes zoster infection in vaccinated patients was significantly lower compared with the general population. 57 This study also demonstrated that unvaccinated patients with IBD were six times more likely to develop Herpes zoster infection than the general population. Despite, the proven efficacy of recombinant zoster vaccine against a preventable disease, several barriers exist that prevent widespread adoption into healthcare programmes, such as cost, patient education and global availability.…”

Section: F I G U R Ementioning

confidence: 51%

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Systematic review with network meta‐analysis: Risk of Herpes zoster with biological therapies and small molecules in inflammatory bowel disease

Din

Selinger

Black

et al. 2022

Aliment Pharmacol Ther

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Background: Biologics and small molecules for inflammatory bowel disease (IBD) may increase infection risk. Herpes zoster causes acute and long-term symptoms, but vaccination is not recommended in patients with IBD, unless >50 years of age. Aims:To examine risk of Herpes zoster infection with all licensed biologics and small molecules for IBD using network meta-analysis. Methods:We searched the literature to 4th October 2022, for randomised controlled trials of these drugs in luminal Crohn's disease or ulcerative colitis reporting data on occurrence of Herpes zoster infection during follow-up. We used a frequentist approach and a random effects model, pooling data as relative risks (RRs) with 95% confidence intervals (CIs). Results: We identified 25 trials (9935 patients). Only tofacitinib 10 mg b.d. (RR = 6.90; 95% CI 1.56-30.63, number needed to harm (NNH) = 97; 95% CI 19-1022) and upadacitinib 45 mg o.d. (RR = 7.89; 95% CI 1.04-59.59, NNH = 83; 95% CI 10-14,305)were significantly more likely to increase risk of Herpes zoster infection. Janus kinase inhibitors were the most likely drug class to increase risk of infection, and risk increased with higher doses (RR with lowest dose = 3.16; 95% CI 1.02-9.84,

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Section: Discussionmentioning

confidence: 59%

Section: F I G U R Ementioning

confidence: 51%

Section: F I G U R Ementioning

confidence: 51%

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Systematic review with network meta‐analysis: Risk of Herpes zoster with biological therapies and small molecules in inflammatory bowel disease

Din

Selinger

Black

et al. 2022

Aliment Pharmacol Ther

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“…Instead, the inactivated herpes zoster vaccine is prescribed for these patients. The inactivated vaccine has been approved for adults aged > 50 years, but its efficacy is not fully confirmed in patients with IBD, especially those receiving immunosuppressive therapy [ 92 ]. Because inoculation with the inactivated herpes zoster vaccine is paid for by the patients themselves, it will be economically burdensome.…”

Section: Inactivated Vaccinesmentioning

confidence: 99%

Expert consensus on vaccination in patients with inflammatory bowel disease in Japan

et al. 2023

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Immunosuppressive therapies can affect the immune response to or safety of vaccination in patients with inflammatory bowel disease (IBD). The appropriateness of vaccination should be assessed prior to the initiation of IBD treatment because patients with IBD frequently undergo continuous treatment with immunosuppressive drugs. This consensus was developed to support the decision-making process regarding appropriate vaccination for pediatric and adult patients with IBD and physicians by providing critical information according to the published literature and expert consensus about vaccine-preventable diseases (VPDs) [excluding cervical cancer and coronavirus disease 2019 (COVID-19)] in Japan. This consensus includes 19 important clinical questions (CQs) on the following 4 topics: VPDs (6 CQs), live attenuated vaccines (2 CQs), inactivated vaccines (6 CQs), and vaccination for pregnancy, childbirth, and breastfeeding (5 CQs). These topics and CQs were selected under unified consensus by the members of a committee on intractable diseases with support by a Health and Labour Sciences Research Grant. Physicians should provide necessary information on VPDs to their patients with IBD and carefully manage these patients’ IBD if various risk factors for the development or worsening of VPDs are present. This consensus will facilitate informed and shared decision-making in daily IBD clinical practice.

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“…In this study, VE against PHN in those receiving two doses was 76.0% (95% CI 68.4–81.8) [ 61 ]. Furthermore, two studies assessed RVZ in patients with inflammatory bowel disease (IBD) [ 62 , 63 ]. There was a lower HZ infection risk in those with IBD ≥ 50 years of age who were vaccinated with RVZ (n = 1670) compared with those with IBD who were unvaccinated (n = 112,200) (OR = 0.36; 95% CI 0.23–0.56) [ 63 ].…”

Section: The Global Use Of Zoster Vaccinesmentioning

confidence: 99%

Risk factors for herpes zoster: should people with asthma or COPD be vaccinated?

et al. 2023

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Without vaccination, an estimated 1 in 3 individuals will develop herpes zoster (HZ) in their lifetime. Increased risk of HZ is attributed to impaired cell-mediated immunity, as observed in age-related immunosenescence or in individuals immunocompromised due to disease or immunosuppressive treatments. Most vaccination guidelines recommend HZ vaccination in all adults ≥ 50 years of age, although Shingrix® was recently approved by the U.S. Food and Drug Administration for use in individuals aged ≥ 18 years who are or will be at increased risk of HZ due to immunodeficiency or immunosuppression caused by known disease or therapy, followed by approval by the European Medicines Agency for use in immunocompromised individuals aged ≥ 18 years. Chronic respiratory diseases are also risk factors for HZ. A new meta-analysis reported 24% and 41% increased risks of HZ in those with asthma and chronic obstructive pulmonary disorder (COPD), respectively, compared with healthy controls. Asthma and COPD increase a person’s risk of HZ and associated complications at any age and may be further elevated in those receiving inhaled corticosteroids. Despite the increased risks, there is evidence that HZ vaccination uptake in those aged ≥ 50 years with COPD may be lower compared with the age-matched general population, potentially indicating a lack of awareness of HZ risk factors among clinicians and patients. The 2022 Global Initiative for Chronic Lung Disease report recognizes that Centers for Disease Control and Prevention recommended to vaccinate those aged ≥ 50 years against HZ, although health systems should consider the inclusion of all adults with asthma or COPD into their HZ vaccination programs. Further research into HZ vaccine efficacy/effectiveness and safety in younger populations is needed to inform vaccination guidelines. Graphical Abstract

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Effectiveness of recombinant zoster vaccine (RZV) in patients with inflammatory bowel disease

Cited by 13 publications

References 11 publications

Systematic review with network meta‐analysis: Risk of Herpes zoster with biological therapies and small molecules in inflammatory bowel disease

Systematic review with network meta‐analysis: Risk of Herpes zoster with biological therapies and small molecules in inflammatory bowel disease

Expert consensus on vaccination in patients with inflammatory bowel disease in Japan

Risk factors for herpes zoster: should people with asthma or COPD be vaccinated?

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