Administration of recombinant zoster vaccine in immune-mediated inflammatory diseases (IMID) individuals was generally well-tolerated. However, in the first 12 weeks following vaccination, mild flares were not uncommon.  

A retrospective study was performed to explore the safety of recombinant zoster vaccine in individuals suffering from IMID.

Participants who were given recombinant zoster vaccine in a single-center rheumatology department were retrospectively incorporated. The IMID flare was characterized as (i) flare documentation in the office notes or participant portal communication or (ii) novel prescription of prednisone in the 12 weeks after each dose.

In total, 622 patients were incorporated (median age 67 years), 8.5% of them witnessed adverse events and Herpes Zoster incidence was 0.6% following the median follow-up of about 36 weeks. Of 359 IMID subjects: 88 had rheumatoid arthritis (25%), 50 vasculitis (14%), 29 polymyalgia rheumatica (8%). At the vaccination, 35% were on glucocorticoids. In total, 59 subjects (16%) witnessed a flare, 18 flares took place in temporal relation to a therapy alteration (31%).

Rheumatoid arthritis subjects had the greatest flare rate (n = 21, 24%). Notably, 25% of subjects who flared needed adjustment of immunosuppression. In a multivariate assessment, the usage of glucocorticoids at vaccination time was linked with flare after vaccination (Odds ratio 2.31 [1.3-4.1]). A time-to-flare survival assessment (Cox-model) demonstrated that glucocorticoids were an important predictor of IMID flare following the initial recombinant zoster vaccine dose (Hazard ratio 2.4 [1.3-4.5]) and that a flare following the initial dose was linked with flaring after the second recombinant zoster vaccine dose (Hazard ratio 3.9 [1.7-9]).

In IMID patients, recombinant zoster vaccine has good tolerability.