Shingles vaccine safe for rheumatoid arthritis patients taking biologic drugs

By: Dr. Victor Marchione | Arthritis | Wednesday, May 04, 2016 - 12:30 PM

Shingles vaccine safe for rheumatoid arthritis patientsShingles vaccine is safe for rheumatoid arthritis (RA) patients taking biologic drugs. Shingles occurs in one in three U.S. adults, with age being a large factor. This is why the vaccine is recommended for those over the age of 50. Rheumatoid arthritis is an autoimmune disease in which the joints are attacked, resulting in stiffness and swelling usually in smaller joints. An estimated 1.3 million Americans live with rheumatoid arthritis and women are twice as likely to develop the condition.

Previously, the shingles vaccine was not recommended for rheumatoid arthritis patients taking biologic medications, but the recent study has shown it to be safe. The researchers studied the safety of the shingles vaccine among 176 rheumatoid arthritis patients who were on either infused or subcutaneous biologics.

Lead author Dr. Stephen Lindsey said, “Every month, I see patients with RA who have had shingles. Despite having an effective vaccine since 2006, our CDC and ACR guidelines do not recommend using it in rheumatic patients on biologics. Studies in 2011 and 2012 suggested no increase in zoster complications inadvertently receiving [herpes zoster] vaccine. We decided to develop and test a protocol to safely vaccinate high-risk patients and help prevent zoster and its complications.”

Eighty percent of infused biologics patients and 50 percent of subcutaneous biologics patients were vaccinated, and no patients developed shingles within six weeks after vaccination. Since 2012, three patients in the infused group and one in the subcutaneous group developed herpes within 10 to 20 months, but no patients developed complications.

Dr. Lindsey added, “Using this protocol, there have been no occurrences of herpes zoster post-vaccination. I feel we can begin to safely vaccinate the thousands of patients who have been on biologics for years and are presently unvaccinated and at high risk.”

Rheumatoid arthritis medication and shingles risk

Experts who studied rheumatoid arthritis and shingles found that RA patients have 1.5 times greater risk of developing shingles, compared to healthy older adults. Shingles stems from the chickenpox virus and emerges once it becomes reactivated in later life. The higher risk of shingles in rheumatoid arthritis may be a result of immunosuppressant drugs that many rheumatoid arthritis patients take.

Dr. Kevin Winthrop, associate professor of infectious diseases at Oregon Health & Sciences University in Portland, explained, “Almost every study shows that using prednisone at dosages commonly prescribed for RA [10 mg/day] doubles the risk of developing shingles.”

In a 2015 study that examined the risk of shingles in rheumatoid arthritis patients on various medications, the researchers found an increased risk of shingles in those taking corticosteroids.

Immediate treatment of shingles is still important in rheumatoid arthritis as it reduces the risk of complications associated with shingles. The most severe complication is post-herpetic neuralgia (PHN), which develops in about 10% to 15% of people who have had shingles.

The best way to prevent shingles is to get vaccinated, which is approved for anyone over the age of 50.

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