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Zoster Vaccination Game: Clinical Practice 3 – ACR Guidelines 0

November 18 2014 12:43 AM ET via RheumReports RheumReports

The ACR reiterated yesterday their recommendation that “Patients treated with biologic agents should not receive live vaccines.” This recommendation is based on the general principle that you do not give a live vaccine to an immunosuppressed person, despite the lack of reports of inducing Herpes zoster (HZ) in patients treated with a biologic agent after HZ immunization.

On the contrary, there is no increase in the rate of HZ in patients treated with anti-TNF agents compared to non-biologic DMARDS based on a retrospective claims database of patients with IBD, RA, AS, PsA and Pso (JAMA 2013;309:887-895). In another retrospective analysis, no cases of induced HZ were reported in patients vaccinated while receiving a biologic agent (JAMA 2012;308:43-59).

A prospective study presented today (Abstract #1836) reported on vaccination against HZ in patients with RA and SpA. Vaccine was administered instead of the next biologic dose (i.e., 1 dose of biologic was skipped) and MTX was withheld for that week. For RTX, vaccine was administered after ≥6 months and 2-4 weeks prior to the next dose. A total of 176 patients were vaccinated without any HZ cases within the next 6 weeks. There were 4 cases of HZ that occurred in immunized patients between 10 and 16 months after receiving the vaccine.

Despite the presence of positive data and the absence of negative data, the 2015 ACR recommendations continue to advise against administering the zoster vaccine to patients on biologics. They did not specify any safe interval of stopping the biologic before immunizing patients.

The HZ vaccination game is not over…..But rheumatologists are left on the sidelines!


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About the Author

Dr. Boulos Haraoui
Dr. Boulos Haraoui

Dr. Boulos Haraoui is an Associate Professor of Medicine at the Université de Montréal and head of the Clinical Research Unit. His research interests focus on the diagnosis and management of rheumatoid arthritis.

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