Prospective controlled study of the recombinant zoster vaccine in autoimmune rheumatic disease: robust seroconversion despite intravenous cyclophosphamide.
Nadia E Aikawa, Julia B Medeiros, Sandra G Pasoto et al.
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In 30 seconds
This subanalysis of a prospective, randomized, placebo-controlled trial assessed recombinant zoster vaccine (RZV) responses in patients with autoimmune rheumatic disease receiving intravenous cyclophosphamide (IVCYC), compared with patients not receiving IVCYC and healthy controls. After two vaccine doses, seroconversion was similar in the two patient groups (91.9% vs. 91.5%) and lower than in controls (99.4%, p = 0.022). Antibody titres were comparable between patient groups, while cellular responses and disease flares did not differ significantly. No severe adverse events were reported.
Key findings
- Seroconversion was 91.9% with IVCYC and 91.5% without IVCYC, compared with 99.4% in healthy controls (p = 0.022).
- Post-vaccination geometric mean titres were comparable between the two autoimmune rheumatic disease groups (p > 0.999), but lower than in controls (p = 0.006).
- Cellular responses and disease flares did not differ between groups (p > 0.05); no severe adverse events occurred.
Why it matters
IVCYC was not associated with a lower measured humoral response than that seen in autoimmune rheumatic disease patients not receiving the drug. These findings help inform consideration of RZV in this treatment context, while the lower responses than in healthy controls underscore that immune responses may not be equivalent across populations.
What to keep in mind
The IVCYC group was smaller than the other groups, and the abstract reports immune responses and safety rather than clinical prevention of shingles.