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Live Attenuated Zoster Vaccine Safe for Patients Receiving TNF Inhibitors

No cases of varicella infection found; cumulative incidence of varicella infection or shingles was 0 percent

By Physician's Briefing Staff | September 27, 2021


For patients receiving tumor necrosis factor (TNF) inhibitors, the live attenuated zoster vaccine (ZVL) is safe and has reasonable short-term effectiveness, according to a study published online Sept. 28 in the Annals of Internal Medicine.

Jeffrey R. Curtis, M.D., M.P.H., from the University of Alabama at Birmingham, and colleagues examined the safety and immunogenicity of ZVL among adults aged 50 years or older receiving TNF inhibitors for any indication. A total of 617 adults were randomly assigned in a 1:1 ratio to receive ZVL or placebo (310 and 307, respectively) at 33 centers.

The most common indications for TNF inhibitor use were rheumatoid arthritis and psoriatic arthritis (57.6 and 24.1 percent, respectively). The researchers observed no cases of confirmed varicella infection through week 6; the cumulative incidence of varicella infection or shingles was 0 percent. Compared with baseline, at six weeks, the mean increases in geometric mean fold rise as measured by glycoprotein enzyme-linked immunosorbent assay and enzyme-linked immunosorbent spot were 1.33 and 1.39 percentage points, respectively.

"Although country-specific labeling requirements may continue to discourage use of a live virus vaccine in immunosuppressed patients receiving biologic therapies, use of this ZVL in TNF inhibitor-treated patients may be a reasonable option, especially in the absence of an alternative zoster vaccine," the authors write.

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