The case for Zostavax vaccination in systemic lupus erythematosus

Cogman, Abigail; Chakravarty, Eliza F.

doi:10.1016/j.vaccine.2013.05.085

Cited by 9 publications

(7 citation statements)

References 24 publications

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“…HZ reactivation is fairly common in patients with systemic lupus erythematosus (SLE) 6–9. The prevalence of HZ reactivation in SLE ranges from 6.4 to 91.4 cases per 1000 patient-year 8.…”

Section: Introductionmentioning

confidence: 99%

“…HZ reactivation is fairly common in patients with systemic lupus erythematosus (SLE) 6–9. The prevalence of HZ reactivation in SLE ranges from 6.4 to 91.4 cases per 1000 patient-year 8. 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.…”

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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“…HZ reactivation is fairly common in patients with systemic lupus erythematosus (SLE) 6–9. The prevalence of HZ reactivation in SLE ranges from 6.4 to 91.4 cases per 1000 patient-year 8.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…Despite these promising results, it remains unclear if vaccination against herpes zoster is safe and effective in patients with an autoimmune inflammatory rheumatic disease (). The American College of Rheumatology (ACR) recommended vaccination against herpes zoster in patients with rheumatoid arthritis even during treatment with disease‐modifying antirheumatic drugs (DMARDs) ().…”

mentioning

confidence: 99%

Altered Cellular and Humoral Immunity to Varicella‐Zoster Virus in Patients With Autoimmune Diseases

Rondaan

Haan

Horst

et al. 2014

Arthritis & Rheumatology

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Objective. Patients with autoimmune diseases such as systemic lupus erythematosus (SLE) and granulomatosis with polyangiitis (Wegener's) (GPA) have a 3-20-fold increased risk of herpes zoster compared to the general population. The aim of this study was to evaluate if susceptibility is due to decreased levels of cellular and/or humoral immunity to the varicellazoster virus (VZV).Methods. A cross-sectional study of VZV-specific immunity was performed in 38 SLE patients, 33 GPA patients, and 51 healthy controls. Levels of IgG and IgM antibodies to VZV were measured using an in-house glycoprotein enzyme-linked immunosorbent assay (ELISA). Cellular responses to VZV were determined by interferon-␥ (IFN␥) enzyme-linked immunospot (ELISpot) assay and carboxyfluorescein succinimidyl ester (CFSE) dye dilution proliferation assay.Results. Levels of IgG antibodies to VZV were increased in SLE patients as compared to healthy controls, but levels of IgM antibodies to VZV were not. Antibody levels in GPA patients did not differ significantly from levels in healthy controls. In response to stimulation with VZV, decreased numbers of IFN␥ spot-forming cells were found among SLE patients (although not GPA patients) as compared to healthy controls. Proliferation of CD4؉ T cells in response to stimulation with VZV was decreased in SLE patients but not GPA patients.Conclusion. SLE patients have increased levels of IgG antibodies against VZV, while cellular immunity is decreased. In GPA patients, antibody levels as well as cellular responses to VZV were comparable to those in healthy controls. These data suggest that increased prevalence of herpes zoster in SLE patients is due to a poor cellular response. Vaccination strategies should aim to boost cellular immunity against VZV.Herpes zoster (shingles) is caused by reactivation of the varicella-zoster virus (VZV) (1,2). It presents as an acute neurocutaneous disease characterized by severe pain and rash in a dermatomal distribution (3). Postherpetic neuralgia, defined as pain lasting Ͼ90 days after onset of rash, is the most common complication of herpes zoster and is estimated to occur in 8-27% of patients (4-7). Herpes zoster and postherpetic neuralgia can have a major impact on quality of life and productivity of a patient (4,5). In particular, elderly individuals and individuals with compromised immune systems are at increased risk of developing herpes zoster and, accordingly, postherpetic neuralgia (3,6).Systemic lupus erythematosus (SLE) and granulomatosis with polyangiitis (Wegener's) (GPA) both are autoimmune inflammatory rheumatic diseases. Patients with an autoimmune inflammatory rheumatic disease are at increased risk of infections including herpes zoster, as a result of the immunosuppressive effect of the disease and/or the use of immunomodulatory medication (8-10). Herpes zoster is found in 15-91 cases per 1,000 patient-years among SLE patients and 45 cases per 1,000 patient-years among GPA patients (3,11,12). Since the incidence of herpes zoster in developed countries is...

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“…20 Live attenuated VZV vaccines are effective in healthy individuals; however, vaccine delivery is debatable in immunocompromised patients because of a potential risk of viremia. 33 Furthermore, the involvement of cytokine imbalance in DM or PM and HZ should be considered in future therapy development.…”

Section: Discussionmentioning

confidence: 99%

Increased Risk of Herpes Zoster Following Dermatomyositis and Polymyositis

et al. 2015

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This study explored the possible association between dermatomyositis or polymyositis (DM or PM) and the subsequent risk of herpes zoster (HZ).We used data from the Taiwan National Health Insurance (NHI) system to address the research topic. The exposure cohort comprised 2023 patients with new diagnoses of DM or PM. Each patient was frequency matched according to age, sex, index year, and comorbidities including diabetes, renal disease, obesity, malignancy, rheumatoid arthritis, immunodeficiency virus infection, autoimmune disease not elsewhere classified, mixed connective tissue disease, or vasculitis with 4 participants from the general population who did not have a history of HZ (control cohort). Cox proportional hazards regression analysis was conducted to estimate the relationship between DM or PM and the risk of subsequent HZ.The incidence of HZ in the exposure and control cohorts was 35.8 and 7.01 per 1000 person-years, respectively. The exposure cohort had a significantly higher overall risk of subsequent HZ than did the control cohort (adjusted hazard ratio [HR] = 3.90, 95% confidence interval [CI] = 3.18–4.77). The risk of HZ in patients with DM or PM in whichever stratification (including sex, age, and comorbidity) was also higher than that of the control cohort.The findings from this population-based retrospective cohort study suggest that DM or PM is associated with an increased risk of subsequent HZ. A synergistic effect was observed between DM or PM and one of the comorbidities.

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The case for Zostavax vaccination in systemic lupus erythematosus

Cited by 9 publications

References 24 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

Altered Cellular and Humoral Immunity to Varicella‐Zoster Virus in Patients With Autoimmune Diseases

Increased Risk of Herpes Zoster Following Dermatomyositis and Polymyositis

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