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Live Zostavax vaccine appears safe in patients with RA treated with Xeljanz
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SAN FRANCISCO – Patients with rheumatoid arthritis who had prior immunity to varicella zoster and received Zostavax live varicella virus vaccine followed by treatment with Xeljanz did not have complications following vaccination, according to recently published research.
Researchers recruited 112 patients aged older than 50 years with active rheumatoid arthritis (RA) despite methotrexate therapy for at least 4 months prior to enrollment. Patients were excluded in the presence of prior herpes zoster vaccination or any vaccination in the preceding 6 weeks, and the two patient groups were similar in composition.
Eligible patients received Zostavax (zoster vaccine live, Merck), then were randomized after 2 weeks to either 5-mg Xeljanz (tofacitinib, Pfizer) twice a day (n = 55) or placebo (n = 57). The varicella zoster virus-specific immunoglobulin G (IgG) and T cell enumeration were measured in samples prior to immunization and at 2, 6 and 14 weeks following vaccination.
At 2 weeks, the geometric mean fold rise (GMFR) in varicella zoster virus-specific IgG titer was 2.11 in the treatment group and 1.74 in the placebo group, both comparable to a healthy population, according to the researchers. A 1.5-fold rise in IgG titer at 6 weeks was observed in 57.4% of patients in the treatment group and 43.4% in the placebo group, and a similar increase in T cells was observed.
One patient in the tofacitinib group developed cutaneous dissemination with the vaccine Oka strain 2 days after initiation of tofacitinib. A lack of pre-existing immunity to the varicella zoster virus was confirmed. No serious adverse events occurred in the placebo group. – by Shirley Pulawski
Reference:
Winthrop K, et al. Paper #12L. Presented at: American College of Rheumatology Annual Meeting; Nov. 7-11, 2015; San Francisco.
Disclosure: Winthrop reports the receipt of funding from AbbVie, Amgen, BMS, Galápagos, Lilly, Pfizer and UCB. Please see the full study for a list of all other authors’ relevant financial disclosures.