Herpes zoster vaccine effective, shows ‘no signs’ of increased severe flare risk in lupus
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WASHINGTON — Herpes zoster vaccination is effective in patients with systemic lupus erythematosus and multiple sclerosis, without increasing the risk for severe lupus flares, according to data presented at ACR Convergence 2024.
“We know that herpes zoster is common in patients with autoimmune conditions such as systemic lupus erythematosus and multiple sclerosis,” Michael George, MD, MSCE, assistant professor of medicine at the University of Pennsylvania, in Philadelphia, told Healio. “Even though the recombinant zoster vaccine is recommended for adults 19 years and older who are immunosuppressed, many people with lupus and multiple sclerosis have not been vaccinated.
“Although there is good efficacy and safety data among older adults and in immunocompromised patients, we think that part of the problem may be that there are no published trials of the vaccine in people with autoimmune disease,” he added. “People may wonder how well the vaccine will work for them and whether it might lead to more autoimmune disease flares.”
To examine the effectiveness and subsequent risk for flares associated with the two-dose herpes zoster vaccine in patients with SLE or multiple sclerosis, George and colleagues analyzed insurance data from adult patients with either disease. In separate analyses of commercial insurance data and Medicare data, vaccinated patients with SLE or MS were matched 1:4 to unvaccinated patients with the same disease.
Vaccine effectiveness was measured through diagnoses of herpes zoster, plus an oral antiviral within 7 days, within 31 days of the second dose. Meanwhile, the researchers evaluated safety via the incidence of severe SLE flares within 90 days of the second vaccine dose.
The commercial insurance analysis included 1,308 patients with SLE and 6,025 with multiple sclerosis. According to the researchers, the effectiveness of two-dose herpes zoster vaccination in this analysis was 54% (95% CI, 70-88). In the Medicare analysis, among 2,284 patients with SLE and 8,705 with MS, the effectiveness was 70% (95% CI, 50-82).
The safety analysis included patients with either one or two vaccine doses and consisted of 2,775 individuals with commercial insurance and 4,227 on Medicare. According to the researchers, the risk for severe SLE flare did not increase in the 90 days following vaccination among the commercially insured (HR = 0.94; 95% CI, 0.72-1.24) or those on Medicare (HR = 0.91; 95% CI, 0.75-1.11).
“People with lupus and multiple sclerosis who received the recombinant zoster vaccine were at substantially lower risk for herpes zoster than people who were unvaccinated,” George said. “Clinicians can also reassure people with lupus that we saw no signs of an increased risk for severe lupus flare in people who received the recombinant zoster vaccine. We hope that our data, specific to people with lupus and multiple sclerosis, can help clinicians discuss the benefits of vaccination with people who have autoimmune diseases. We hope to learn even more as this study continues.”
According to George, the next step to consider is the effect of different medications.
“We have future studies planned as part of this ongoing study to evaluate how different immunosuppressive medications affect recombinant zoster vaccine effectiveness,” he said. “We also need more studies to assess and address the barriers to vaccination in people with autoimmune disease.”
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Kluberg S. Abstract #0844. Presented at: ACR Convergence 2024; Nov. 14-19, 2024; Washington, D.C.
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