Atlanta, GA—An analysis presented at the Society for Medical Decision Making’s 36th Annual North American Meeting suggests that it may be beneficial to routinely immunize patients with rheumatoid arthritis (RA) against herpes zoster (HZ).
The HZ vaccine is contraindicated for patients with RA and patients who are immunosuppressed because it increases the risk for an acute HZ episode, which may lead to vaccine-related visceral dissemination. Although vaccine-related visceral dissemination is potentially life-threatening, the literature suggests that death only occurs in severely immunocompromised patients treated for multiple comorbid conditions and not RA, according to lead investigator Marc Vacquier, MSc, Division of Health Policy and Management, University of Minnesota, Minneapolis, and colleagues. Without the vaccination, the risk for HZ in patients with RA is approximately double that of the general population, the investigators added.
Mr Vacquier and colleagues used a mathematical Markov model to simulate a hypothetical cohort of patients with RA aged 60 years receiving traditional nonbiologic disease-modifying antirheumatic drugs and who did or did not receive the HZ vaccination. The model was created with a 30% risk for vaccine-induced visceral dissemination.
“This is a conservative estimate considering that in 2 studies where a combined 19,197 immunocompromised patients received off-label use of the vaccine there were no reports of vaccine-induced visceral dissemination,” said Mr Vacquier. The vaccine’s effectiveness in reducing the incidence of postherpetic neuralgia, which is the most common HZ complication, was not included in the analysis.
“We intentionally excluded the potential reduction in the incidence of postherpetic neuralgia to allow us to conservatively estimate the benefit of reducing the incidence of HZ alone as a baseline measure of vaccine effectiveness in RA,” Mr Vacquier told Value-Based Care in Rheumatology.
As long as the risk of vaccine- induced visceral dissemination is less than 1/250,000, the benefits of vaccination outweigh the risks, the investigators reported. Vaccination was associated with an increase of 0.3 quality-adjusted months per patient—a measure of remaining life- years and the quality of life associated with those years, the investigators found. Furthermore, increasing the patients’ risk for HZ raised the threshold whether to vaccinate.
“Based on the literature and results of our decision-analytic model, the HZ vaccine could be beneficial for RA patients…after they have discussed the implications of [taking] this course of action with their rheumatologist,” the investigators concluded. “If both the RA patient and their provider agree on vaccination, then the patient should report any adverse events to their rheumatologist and should be ready to start antiviral treatment within 72 hours if [vaccine-related dissemination occurs].”