Is the Zoster Vaccine Needed When Initiating Immunosuppressant Therapy?
SAN DIEGO, CA—Biologics—and particularly non-tumor necrosis factor (TNF)-α blockers—might increase the risk of herpes zoster in immunocompromised individuals, authors of a systematic review and meta-analysis reported at IDWeek 2015. The researchers also identified a similar trend for nonbiologic disease-modifying antirheumatic drugs (nbDMARDs).
“These findings raise the issue of prophylaxis with zoster vaccines in patients initiating treatment with immunosuppressives for autoimmune diseases,” reported Elaine Lo, PharmD, of the University of British Columbia, Vancouver, BC, Canada, and coauthors.
Herpes zoster infection rates are 3 to 5 per 1,000 person years, and these rates have increased over time, they noted. However, previous studies of the risk of medications have been inconsistent. The researchers therefore sought to determine the association of biologics, DMARDS, corticosteroids, or combinations of agents in herpes zoster risk.
The investigators conducted a systematic literature search for English-language studies reporting herpes zoster outcomes among adults undergoing immunosuppressive therapies for autoimmune diseases, dated from January 1946 to February 2015.
Of the 3,756 studies identified, 44 were included in the qualitative meta-analysis: 29 randomized controlled trials (n=41,547) and 15 observational studies (n=676,979).
Biologics were found to be associated with a greater risk of herpes zoster than control therapy, which was defined as placebo or lack of treatment being compared, with an odds ratio (OR) of 1.79 (95% confidence interval [CI]: 1.14, 2.83) in the randomized controlled trials and an OR of 1.70 (95% CI: 1.44, 1.99) in the observational studies.
“In randomized controlled trials, the OR of non-TNF blockers was 2.17 (95% CI: 1.18, 3.98) but that of the TNF blockers was not statistically significant from control” (1.37; 95% CI: 0.68, 2.75), they reported.
In observational studies, but not in randomized controlled trials, a small increased risk of herpes zoster was observed with both non-biologic nbDMARDS (OR 1.21, 95% CI: 1.14, 1.30) and corticosteroids (OR 1.76, 95% CI: 1.59, 1.94).
“Findings did not vary when examined in subgroups by disease, mean age, and randomized controlled trial outcomes categorized according to adverse events and serious adverse events,” they noted, adding that “none demonstrated significant association with herpes zoster risk.”