Herpes zoster vaccination in systemic lupus erythematosus: the current status

Mok, Chi Chiu

doi:10.1080/21645515.2018.1514228

Cited by 25 publications

(20 citation statements)

References 34 publications

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“…Despite the increased risk of HZ infection, SLE had the lowest HZ vaccination rates among age-eligible subjects,9 probably because of the concern of vaccine safety, the principle of contraindication to live-attenuated vaccines in immunocompromised hosts, as well as the current ambiguous guidelines for HZ vaccination in SLE 10. The US Centers for Disease Control and Prevention only recommends the live-attenuated HZ vaccine in patients receiving low-to-moderate immunosuppression such as short-term corticosteroid therapy (<14 days), low to moderate doses of corticosteroid (<20 mg/day prednisolone), methotrexate (<0.4 mg/kg/week) and azathioprine (<3 mg/kg/day) 22.…”

Section: Discussionmentioning

confidence: 99%

“…However, the definition of ‘less serious’ immunosuppression is not explicit. The recent availability of the non-live subunit and inactivated HZ vaccines might provide more opportunities for SLE patients to be protected against HZ reactivation as they do not contain the live virus that may cause disseminated infection in patients on heavy immunosuppression 10. Despite the lack of head-to-head comparative studies, a recent network meta-analysis showed that the recombinant adjuvant subunit vaccine may be more effective than the live vaccine in preventing HZ reactivation in older healthy individuals 24.…”

Section: Discussionmentioning

confidence: 99%

“…A recent longitudinal study reported that SLE patients had more HZ infection at all ages, with an age-adjusted incidence of 12.0/1000 person-years compared with controls (8.7/1000 person-years) (HR 1.7) 9. Risk factors associated with HZ infection in SLE included immunosuppressive therapies, renal and major organ disease, lymphopenia, malignancies and other comorbidities, as well as certain autoantibodies 10. However, these factors are inconsistent across studies, probably because of small samples and the difference in patient selection.…”

Section: Introductionmentioning

confidence: 99%

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Safety and immune response of a live-attenuated herpes zoster vaccine in patients with systemic lupus erythematosus: a randomised placebo-controlled trial

Mok

Chan

et al. 2019

Ann Rheum Dis

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ObjectivesTo study the safety and immunogenicity of a live-attenuated herpes zoster (HZ) vaccine in patients with systemic lupus erythematosus (SLE).MethodsAdult SLE patients having a SLEDAI <6 and stable immunosuppressive treatment for ≥6 months were recruited. Participants were randomly assigned to receive HZ vaccine (Zostavax) or placebo injection. Anti-varicella zoster virus (VZV) IgG reactivity (baseline and week 6) was measured by an enzyme-linked fluorescence assay. Cell-mediated response was assessed by a VZV-stimulated interferon-gamma (IFN-γ) enzyme-linked ELISPOT assay. Adverse events and immune responses of the two groups were compared.Results90 SLE patients were recruited (age 45.6±14.1 years; 93% women) and assigned to Zostavax or placebo (in 1:1 ratio). Baseline clinical parameters were similar between the two groups. The change in anti-VZV IgG from week 0 to 6 was +59.8% in the vaccine and −2.1% in the placebo group. Week 6 anti-VZV IgG was significantly higher in vaccinated than placebo-treated patients, after adjustment for baseline (4.16±1.26 vs 3.32±1.01; p<0.001). The number of IFN-γ secreting T-cell spots decreased in the placebo-treated patients (−17%) but increased in vaccinated patients (+42%). The T-cell spots number at week 6 was significantly higher in vaccine—than placebo-treated patients after adjustment for baseline (38.1±78.2 vs 23.1±47.9; p=0.02). Significantly more vaccinated patients reported self-limiting injection site reaction than controls (31% vs 7%; p<0.01). Two vaccinated patients (4.4%) and one (2.2%) placebo-treated patient had mild/moderate SLE flares but no patients developed HZ eruption within 6 weeks postvaccination.ConclusionsIn patients with stable SLE not receiving intensive immunosuppression, Zostavax was well-tolerated and provoked an immune response.Trial registration numberUS ClinicalTrials.gov registry (NCT02477150).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Safety and immune response of a live-attenuated herpes zoster vaccine in patients with systemic lupus erythematosus: a randomised placebo-controlled trial

Mok

Chan

et al. 2019

Ann Rheum Dis

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“…7,12 However, these factors are inconsistent across studies, probably because of small samples, selection bias and the heterogeneity of patients included. 19 Moreover, specific rates of herpes zoster reactivation in well-defined subsets of SLE patients have not been reported before. In view of the paucity of data in Chinese patients, this work was conducted to look at the incidence of herpes zoster infection in patients with biopsy proven lupus nephritis undergoing immunosuppressive therapies.…”

Section: Introductionmentioning

confidence: 97%

Prevalence and risk factors of herpes zoster infection in patients with biopsy proven lupus nephritis undergoing immunosuppressive therapies

Mok

Tse

Chan

et al. 2020

Lupus

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Objectives To study the prevalence of herpes zoster infection in patients with biopsy-confirmed lupus nephritis undergoing immunosuppressive therapies. Methods Patients who had histologically active lupus nephritis between 2004 and 2018 were retrospectively reviewed. Clinical and laboratory data at baseline and six months post-therapy were collected. The incidence of herpes zoster reactivation within two years of lupus nephritis treatment was calculated. Risk factors for herpes zoster reactivation were studied by logistic regression. Results Patients ( N = 251) with 311 episodes of lupus nephritis were studied (92% women; age 34.2 ± 14.2 years; histological classes III/IV ± V (69%)). Within two years of therapy, 55 (18%) episodes of lupus nephritis were complicated by herpes zoster infection (incidence 8.84/100 patient-years). Fourteen episodes (25%) of herpes zoster were treated by intravenous anti-viral drugs in hospital but disseminated disease or mortality was not reported. Significant post-herpetic neuralgia developed in 9% of the episodes. Patients with herpes zoster reactivation, compared with those without, were more likely to have first-time renal disease and a shorter systemic lupus erythematosus duration at lupus nephritis than those without. Disease activity, treatment response and other clinical/laboratory parameters were not significantly different between patients with and without herpes zoster reactivation. Herpes zoster-infected patients had been treated with a significantly higher dose of prednisolone as induction therapy. Logistic regression revealed that first-time renal disease, peak daily mycophenolate mofetil dose and cumulative cyclophosphamide dose during induction therapy were significantly associated with herpes zoster reactivation. Conclusions Herpes zoster reactivation is common in lupus nephritis patients but unpredictable from clinical parameters. Although adverse outcomes of herpes zoster infection are uncommon, using the minimally effective doses of mycophenolate mofetil and cyclophosphamide during induction therapy may help reduce the risk of herpes zoster infection.

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“…Patients with active SLE who need more intensive immunosuppressive (IS) therapy were more predisposed to VZV infections 5 6. However, mild or even inactive patients could also have VZV infections, and they account for about two-thirds of the events 5–7. A case–control study has described that there was close association between VZV reactivation and SLE diagnosis 8.…”

Section: Introductionmentioning

confidence: 99%

Varicella zoster virus infections increase the risk of disease flares in patients with SLE: a matched cohort study

Sun¹,

Chen²,

Wu³

et al. 2019

Lupus Sci Med

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ObjectiveTo explore whether varicella zoster virus (VZV) infection could increase the risk of disease flares in patients with SLE.MethodsPatients who had VZV reactivations between January 2013 and April 2018 were included from the SLE database (n=1901) of Shanghai Ren Ji Hospital, South Campus. Matched patients with SLE were selected as background controls with a 3:1 ratio. Patients with SLE with symptomatic bacterial infections of the lower urinary tract (UTI) were identified as infection controls. Baseline period and index period were defined as 3 months before and after infection event, respectively. Control period was the following 3 months after the index period. Flare was defined by SELENA SLEDAI Flare Index. Kaplan-Meier analysis, Cox regression model and propensity score weighting were applied.ResultsPatients with VZV infections (n=47), UTI controls (n=28) and matched SLE background controls (n=141) were included. 16 flares (34%) in the VZV group within the index period were observed, as opposed to only 7.1% in UTI controls and 9.9% in background controls. Kaplan-Meier curve revealed that patients with a VZV infection had a much lower flare-free survival within the index period compared with the controls (p=0.0003). Furthermore, after adjusting for relevant confounders including baseline disease activity and intensity of immunosuppressive therapy, Cox regression analysis and propensity score weighting confirmed that VZV infection within 3 months was an independent risk factor for SLE flares (HR 3.70 and HR 4.16, respectively).ConclusionsIn patients with SLE, recent VZV infection within 3 months was associated with increased risk of disease flares.

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Herpes zoster vaccination in systemic lupus erythematosus: the current status

Cited by 25 publications

References 34 publications

Safety and immune response of a live-attenuated herpes zoster vaccine in patients with systemic lupus erythematosus: a randomised placebo-controlled trial

Safety and immune response of a live-attenuated herpes zoster vaccine in patients with systemic lupus erythematosus: a randomised placebo-controlled trial

Prevalence and risk factors of herpes zoster infection in patients with biopsy proven lupus nephritis undergoing immunosuppressive therapies

Varicella zoster virus infections increase the risk of disease flares in patients with SLE: a matched cohort study

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