Shingles Vaccine May Be Safe for Autoimmune Disease Patients

A recent study conducted at the University of Alabama at Birmingham shows that the shingles vaccine appears to be safe and effective for those suffering from autoimmune diseases. In the study, data were collected on more than 460,000 Medicare patients who had one of several rheumatic or immune-mediated diseases. Of those, more than 18,600 patients with rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis (an inflammation of the spine) or inflammatory bowel disease received the shingles vaccine. In the 42 days following vaccination, there were no cases of shingles, including among the more than 600 who were taking so-called anti-tumor necrosis factor biologics to treat their other conditions. And, there was only one case of shingles seen among all the patients during that time. More than 42 days after being vaccinated, 138 patients did develop shingles, which is in the range of the effectiveness of the vaccine. After two years of follow-up, the investigators concluded that the vaccine reduces the risk of shingles in these patients. That conclusion also was based on accounting for the type of immune disease, treatment and the use of arthritis drugs and steroids.

Because the shingles vaccine is a live vaccine, the U.S. Food and Drug Administration and other organizations say the vaccine should not be used in patients taking immunosuppressive drugs including all biologic agents and some nonbiologics because these patients may develop shingles from the vaccine virus strain. “A live attenuated vaccine reduces [shingles] risk by 70 percent and 51 percent among immunocompetent individuals 50 to 59 years and 60 years and older in two randomized, blinded trials, respectively,” the researchers wrote. And, “the risk of [shingles] is elevated by one-and-a-half to two times in patients with rheumatic and immune-mediated diseases such as rheumatoid arthritis and Crohn’s disease. This increase has been attributed to both the underlying disease process and treatments for these conditions.”

According to Dr. Bruce Hirsch, an attending physician in infectious diseases at North Shore University Hospital in Manhasset, N.Y., who was not involved in the study, “The findings are reassuring for a very specific group of patients.” However, the study does not address the vaccine in patients who have weakened immune systems related to other causes, Hirsch said. And, he cautions that the vaccine does have some risks and there is no long-term data on its effectiveness in these patients. “I don’t consider this study to be completely definitive,” Hirsch said. “The book isn’t closed, but I am cautiously optimistic. The vaccine seems to be safe, and these kinds of patients are able to handle the vaccine and get a benefit from it.”

The study was published on Jul. 4, 2012, in the Journal of the American Medical Association.