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Patients Taking TNF Inhibitors Can Safely Receive Zostavax

Key clinical point: Patients taking tumor necrosis factor inhibitors did not develop varicella infection after receiving a live-attenuated version of the varicella vaccine (Zostavax).

Major finding: There were no confirmed varicella infection cases at 6 weeks.

Study details: A blinded, randomized, placebo-controlled trial of 617 participants taking tumor necrosis factor inhibitors who received the live-attenuated version of the varicella vaccine (Zostavax) or placebo.

Disclosures: The VERVE trial was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Curtis reported serving as a current member of the Center for Disease Control and Prevention’s Advisory Committee on Immunization Practices Herpes Zoster Work Group. He and some of the other authors reported financial relationships with many pharmaceutical companies.

Citation:

Curtis J et al. Arthritis Rheumatol. 2019;71(suppl 10), Abstract 824.

Commentary:

Patients with autoimmune disorders are generally considered to be immunocompromised, while also requiring immunosuppressive medication for treatment. Thus, the use of live vaccines, such as Zostavax, has been discouraged in patients taking biologic medications because of the potential for reactivation of the attenuated virus in the vaccine. This study of more than 600 patients at 33 centers in the U.S. is a randomized, placebo-controlled trial of Zostavax to look at rates of reactivation of herpes zoster; most patients had RA, and, thus, many were also taking methotrexate and glucocorticoids. Within the 6 months of follow-up, there were no cases of varicella infection due to reactivation or vaccine-related infection, suggesting that the vaccine should be safe in patients treated with TNF inhibitors, at least given the short-term, follow-up data.— Arundathi Jayatilleke, MD