Psoriasis is a common inflammatory disease of adults and children, affecting up to 3.2% of adults in the United States. An estimated 30% to 33% of those have been diagnosed with psoriatic arthritis.

Systemic therapy and immunosuppression in those patients has been linked to increased risk for herpes zoster (HZ) incidence.

Doctor preparing vaccine. Source: Getty

The question addressed in a recent study was whether patients with psoriasis (PsO) and/or psoriatic arthritis (PsA) are good candidates for the shingles vaccine.

Brigham and Women’s Hospital-led researchers sought to assess HZ risk in patients with PsO/PsA by systemic treatment and provide recommendations regarding HZ vaccination. Their results were reported in the Journal of the American Academy of Dermatology.

Researchers performed a systematic literature search of HZ in patients with PsO/PsA. In addition, HZ vaccination guidelines were reviewed and the medical board of the National Psoriasis Foundation made consensus recommendations in PsO/PsA patients based on graded evidence.

With 41 studies meeting inclusion criteria, the study team determined that the follow carry increased HZ risk (grading of evidence is included):

• systemic corticosteroids (strong, 1),

• tofacitinib (strong, 1), and

• combination therapy with biologic and conventional synthetic disease modifying antirheumatic drugs (weak, 2a).

The study noted that monotherapy with biologic or conventional synthetic disease modifying antirheumatic is not linked to increased HZ risk. Researchers explained that there is insufficient evidence to determine risk with interleukin 12/23, 17, and 23 inhibitors, or apremilast (weak, 2a).

In light of that information, study authors said that recombinant zoster vaccine is recommended for all PsO/PsA patients 50 or older and for younger patients on tofacitinib, systemic steroids, or combination systemic treatment.

Vaccination of patients less than 50 years old on other systemic therapies may be considered on a case-by-case basis, the researchers said.

The study said its findings were limited because of significant heterogeneity between studies.

“HZ risk depends on disease severity and treatment class,” study authors concluded. “Recombinant zoster vaccine should be given to all PsO/PsA patients >50 years old and younger patients at increased risk.”

Recent guidelines from the American Academy of Dermatology and the National Psoriasis Foundation on use of biologics in psoriasis and psoriatic arthritis advised, “Inactivated or ‘dead’ vaccines may be given during treatment with all biologics. For administration of live vaccines, consultation with an infectious disease specialist is recommended.”