Patients with autoimmune issues, such as those with inflammatory bowel disease (IBD), appear to be at increased risk for herpes zoster infection. A question raised in a recent study quantifying that risk was the safety of inactivated zoster vaccine (ZVIN) in patients with autoimmune diseases.
The report in Clinical Gastroenterology & Hepatology sought to quantify elevated risk of herpes zoster in patients with IBD and how much that was influenced by medication. To determine that, a team led by researchers from the University of Pennsylvania Perelman School of Medicine and the Veterans’ Affairs Medical Center, both in Philadelphia, conducted two retrospective studies of populations of U.S. veterans, from January 2000 through June 2016. In determining incidence of herpes zoster, the studies compared IBD patients treated with 5-ASA to patients without the disease and then focused on patients with IBD treated with only 5-ASA, with thiopurines, with antagonists of tumor necrosis factor (TNF), with a combination of thiopurines and TNF antagonists, and with vedolizumab.
Results indicate that, compared to no IBD, ulcerative colitis (UC) and Crohn’s disease (CD) were each associated with significantly increased risk of herpes zoster infection. For example, UC, CD, or IBD treated with 5-ASA treatment alone was associated with significantly increased risk of herpes zoster, with adjusted HRs (AHR) of 1.81 for UC (95% CI, 1.56-2.11); 1.56 for CD (95% CI, 1.28-1.91); and 1.72 for treated IBD (95% CI, 1.51-1.96).
“With the approval of a new and potentially safer vaccine for herpes zoster, the effects of immunization of patients with IBD should be investigated,” study authors suggest.
Another study in Clinical Infectious Diseases did just that.
A study team led by Swedish researchers focused on adults with autoimmune disease who were treated with immunosuppressive therapy (biologic or nonbiologic), randomizing them to receive four doses of inactivated zoster vaccine (ZVIN), ZVIN containing a higher quantity of antigen, or placebo. Blood samples were collected at baseline, and after the second, third, and fourth doses to measure immune responses using glycoprotein enzyme–linked immunosorbent assay (gpELISA) and interferon-gamma enzyme-linked immunospot (IFN-gamma ELISPOT).
The researchers found that ZVIN elicited a statistically significant VZV-specific immune response approximately 28 days postdose 4, measured by gpELISA (estimated geometric mean fold rise from baseline [GMFR] = 1.6 [95% confidence interval [CI], 1.4,1.7], P <.0001) and IFN-gamma ELISPOT (estimated GMFR = 2.0 [95% CI, 1.6,2.6], P <.0001).
Infection-site adverse effects were reported by 57% of the participants receiving ZVIN and 21% of placebo recipients. Serious adverse effects occurred in eight patients receiving ZVIN and one in the placebo group; two in the intervention group were determined to be vaccine related—keratitis and amnesia. Overall, however, frequency of AEs decreased with subsequent vaccine doses.
“In adults with autoimmune disease, ZVIN was well tolerated and elicited statistically significant VZV-specific immune responses approximately 28 days postdose 4, measured by gpELISA and IFN-gamma ELISPOT,” study authors conclude.