Recombinant zoster vaccine reduces HZ-related pain, use of pain medication
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The recombinant zoster vaccine not only effectively prevents herpes zoster, it reduces herpes-zoster-related pain and the use of pain medication, according to data presented at IDWeek.
“Herpes zoster (HZ) can be a very painful disease with debilitating outcomes. It impacts approximately one in three individuals in their lifetime, with significant morbidity and impact on quality of life increasing with age,” David Willer, PhD, global medical affairs lead for GSK, told Healio.
“The most common complication of HZ is a chronic pain condition known as postherpetic neuralgia (PHN), which can occur in up to 30% of patients and last months or even years,” Willer said. “Due to the nature of the disease, adequate pain control and reduction is important.”
Willer explained that mild to moderate pain may be managed through traditional approaches, whereas severe pain often requires opioids or opioid agonists, including morphine, oxycodone, codeine and tramadol.
“All of these systemic treatments have adverse effects, and the high degree of polypharmacy in the treatment of acute HZ and PHN raises concerns of drug-drug interactions and other practical considerations, such as the need for specialized treatment settings, the risks associated with long-term opioid use, and potential diversion or abuse of such medications associated with long-term pain management,” Willer added. “This is especially poignant given the ongoing global opioid crisis.”
Researchers analyzed patients with confirmed HZ from previous phase 3, randomized, placebo-controlled studies ZOE-50, ZOE-70 and ZOE-HSCT, for vaccine efficacy (VE) of the recombinant zoster vaccine (RZV) in reducing the duration of clinically significant HZ-related pain and the use and duration of HZ-related pain medication.
The study demonstrated that VE in reducing the duration of clinically significant HZ-related pain during HZ episodes was 38.5% (P = .0099) in vaccinated patients from the ZOE-HSCT study compared with those receiving placebo. According to the researchers, a similar trend was observed in the ZOE-50 (VE: 26.9%; P = .4318) and ZOE-70 (VE: 28.4%; P = .1877) studies.
Additionally, the study showed that VE reduced the use (39.6%, (p = .0083) and duration (49.3%; P = .0404) of HZ-related pain medication in the ZOE-70 study, whereas corresponding positive VE estimates were seen in the ZOE-50 and ZOE-HSCT studies.
According to the researchers, non-opioids were used by 61.2%, 44.3% and 22.1% of patients in the ZOE-50, ZOE-70 and ZOE-HSCT studies, respectively, whereas weak opioids were used by 18.6%, 13% and 10.8% of patients, and strong opioids by 8%, 2% and 5.3% of patients.
Treatment of HZ is complex and requires a multifaceted approach, with the end goals to minimize the clinical course, provide pain relief, and reduce the incidence and severity of complications, although often with only limited impact,” Willer said. “As a preventive measure, RZV has been proven to be highly efficacious in the prevention of HZ in healthy adults over 50 and in immunocompromised adults over 18 undergoing autologous hematopoietic stem cell transplant.”
“The high vaccine efficacy afforded by RZV results in only a limited frequency of breakthrough cases,” Willer added. “In addition to the prevention of HZ, the reduction of pain — acute and chronic — and reduced need for pain medication in the rare breakthrough cases of HZ could [provide] a substantial benefit to patient quality of life.”
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Kim JH, et al. LB-7. Presented at: IDWeek; Oct. 21-25, 2020 (virtual meeting).
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