Table 10

Efficacy, immunogenicity and safety of live-attenuated herpes zoster vaccination in patients with AIIRD

First author +ref.YearStudy designNo. casesEfficacyImmunogenicitySafetyInfluence IS on eff./imm.LoE
Eff. Imm. Saf.
Winthrop170 2017RCT55 RA MTX+TFC*
Similar CMI response. Trend towards higher humoral response MTX+TFC3 SAE in MTX-TFC group versus 0 in MTX+PCB:
one cholangitis,
one bronchitis and
one disseminated primary varicella in seronegative patient.
Mild AE no difference.
See column immunogenicity.2b4
Russell173 2015RCT206 GC vacc.
(25% PMR)
100 GC PCB-vacc
(31% PMR)
Mostly no AIIRD.
>10–20 mg: n=39
Higher postvacc. humoral response in vacc.More injection-site AE and headache in vacc. Other systemic and serious AE: no difference.No influence of limited daily GC dose2b4
Koh169 2018Cohort41 RA
28 OA
Lower CMI response in RA. Similar humoral response.No SAE. Mild systemic AE in 11.6% of all participants.
6 RA flares during 12 weeks postvacc. Median Disease Activity Index unchanged.
and Yun168
Cohort (retrospective database)Total: 463 541
Vacc: 18 683 (4.0%)
Vacc on biologics: 633
7780 vaccinated patients in analysis
Lower incidence of HZ in vacc. patients.
Rapid decline difference incidence rate vacc. and unvacc.
6 years postvacc: no longer significant.
<42 of vacc: HZ incidence decreased, no cases of hospitalised meningitis or encephalitis, no HZ in patients using biologicsLower HZ incidence in vacc. patients using biologics, DMARDs or GC alone2b4
Guthridge171 2013Cohort10 SLE
10 HC
Similar proportion of subjects with 50% increase in CMI measures postvacc.No difference.
No flares.
  • *Tofacitinib or placebo was started 2–3 weeks postvaccination.

  • †Patients with rheumatoid arthritis (n=292 169), psoriasis (n=89 565), psoriatic arthritis (n=11 030), ankylosing spondylitis (n=4026) and/or inflammatory bowel disease (n=66 751).

  • AIIRD, auto-immune inflammatory rheumatic disease; CMI, cell-mediated immunity; DMARD, disease-modifying antirheumatic drug; eff., efficacy; GC, glucocorticoids; HC, healthy controls; HZ, herpes zoster; imm., immunogenicity; IS, immunosuppressives; LoE, Level of evidence; MTX, methotrexate; No., number; OA, osteoarthritis; PCB, placebo; PMR, polymyalgiarheumatica; RA, rheumatoid arthritis; RCT, randomised controlled trial; ref., reference; (S)AE, serious adverse event(s); Saf., safety; SLE, systemic lupus erythematosus; TFC, tofacitinib; vacc., vaccinated.