AB0681 HERPES ZOSTER INFECTIONS AFTER VACCINATION WITH A RECOMBINANT, ADJUVANTED VACCINE (SHINGRIX) AGAINST HERPES ZOSTER IN RHEUMATOID ARTHRITIS PATIENTS RECEIVING WITH JAK-INHIBITORS
Authors: J. T. Einarsson, H. Källmark, M. Najibi, T. Bergström, M. C. Kapetanovic
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The efficacy of treatment JAK-inhibitors (JAKi) alone or in combination with methotrexate (MTX) in established rheumatoid arthritis (RA) has been demonstrated in numerous studies. However, patients with RA are at higher risk of herpes zoster (HZ) (ref) and treatment with JAKi increases this risk. A non-live, recombinant, adjuvanted HZ vaccine provides good and sustained protection against HZ in adults ≥50 years. Data on the efficacy of this vaccine in RA patients receiving treatments with JAKi as monotherapy or in combination with other synthetic disease modifying anti-rheumatic drugs (sDMARDs) is scarce. <h3>Objectives:</h3> To investigate if vaccination against HZ using a non-live, recombinant, adjuvanted vaccine protects against HZ in patients with established RA receiving treatment with JAKi compared to unvaccinated matched RA controls. <h3>Methods:</h3> In total, 88 patients with long-lasting RA (median age and disease duration 62 and 16 years, respectively; 70% female, mean number of previous sDMARDs=2 and mean number of previous biologics=2), who were treated with JAKis ±sDMARDs (mostly MTX) ± low dose prednisolone and with regular follow up at the out-patients rheumatology department, Skåne University Hospital in Lund/Malmö participated. Of these, 45% were treated with JAKi as monotherapy, 46% JAKi+MTX and 9% JAKi+other sDMARDs. In total, 43% received concomitant prednisolone (median daily dose 5 mg). All participants received two doses of the vaccine administrated intramuscularly 2 months apart. For each study participant, four age, genders and diagnosis matched controls from the same geographic area were identified using the regional healthcare registry (Region Skåne Healthcare registry, RSVD) which covers both hospital and primary care. HZ infections occurring 5 years before (from January 1, 2014) and up to 4 years after completed vaccination i.e. until the first HZ infection after vaccination or April 30, 2023 were retrieved from RSVD using ICD-10 diagnostic codes for HZ (B02.0-B02.9). RA controls were assumed to be unvaccinated due to vaccine shortage on the market during the vaccination period in the study. Infections occurring 2,5 months after the first vaccine dose were considered postvaccination infections. Incidence rate (IR/1000 person years) for infections occurring before and after vaccination were calculated and compared. <h3>Results:</h3> Table 1 shows the number of HZ infections before and after vaccination and the incidence rates (IR) of infections among patients and controls. <h3>Conclusion:</h3> Patients with established RA receiving treatment with JAKi with or without concomitant sDMARDs and/or low dose prednisolone had a significantly higher incidence rate of HZ infections compared to matched RA controls, and IR remained at approximately the same level after being vaccinated with a non-live recombinant vaccine against HZ. Considering the short follow-up time and limited number of infections, these results indicate that the HZ subunit vaccine provide protection against HZ in these particularly vulnerable patients. <h3>REFERENCES:</h3> [1] <i>Södergren E, Mårdberg K, Nishimwe M, et al. Incidence and Burden of Herpes Zoster in Sweden: A Regional Population-Based Register Study. Infect Dis Ther. 2024 Jan 9. doi: 10.1007/s40121-023-00902-1.</i> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> Jon Thorkell Einarsson: None declared, Hanna Källmark: None declared, Morteza Najibi: None declared, Tomas Bergström: None declared, Meliha C Kapetanovic independent research grants from Pfizer.