More studies like VERVE needed to test live vaccines in special populations


The VERVE study highlights a crucial topic for rheumatologists treating patients in clinical practice. The traditional thinking is to inform patients never to receive live vaccines when they are using TNF (tumor necrosis factor) inhibitors to treat their autoimmune disease. The VERVE study indicates that in the case of the Zostavax vaccine, patients on this form of biologic therapy for rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis can safely receive this preventive measure. This study scratches the surface on an important topic, and other studies need to follow.

Many patients on biologic therapy want to travel. Many times, international travel requires vaccination that is only in the form of a live vaccine – for example, the yellow fever vaccine. It would be useful for us to better understand whether other live vaccines can safely be administered and better inform our patients who want to travel. In addition, many times mothers with young infants are nervous if they are on biologic therapy and their children need to receive a live vaccine. They are concerned that their children will shed the live virus and they will be in jeopardy. This study highlights that this may be more of an antiquated way of thinking. We need more studies of this kind to better understand and advise our patients properly without instilling unwarranted fear.

Dr. Elana M. Oberstein of the Univesity of Miami Health System

Dr. Elana M. Oberstein

This study was narrow in nature and we certainly need more information on the safety of Zostavax with patients on biologics with other mechanisms of action such as B-cell depletion and interleukin-6 inhibition. Another limitation in this study was that the majority of the trial population was composed of white females. Of course, these trials, if possible, need to include the pediatric population in whom many live vaccines are lifesaving. The recent outbreak of measles in the United States highlights the importance of a better understanding of live vaccines in populations at risk for this illness. We need to congratulate the study investigators for taking the first steps to change the narrative about live vaccines with evidenced-based medicine. Hopefully more data will follow.

Dr. Oberstein is a practicing rheumatologist at the University of Miami Health System and is senior medical director of musculoskeletal at Modernizing Medicine in Boca Raton, Fla. She has no relevant disclosures to report.

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