By Spondylitis Association of America
Wednesday, November 08, 2017
Biologic medications can play an important role for those living with spondyloarthritis. They may slow the progression of the disease, treat joint/spinal arthritic pain, and can generally alleviate many symptoms. However, like all medications, they have drawbacks for those taking them - one being that patients on biologics can’t receive live vaccines - including, until very recently, the Shingles vaccine.
Shingles is a painful and itchy rash caused by the varicella zoster virus, which is the same microorganism responsible for chickenpox. After the symptoms of chickenpox have disappeared, the virus lies dormant in the patient’s system and can be triggered again, resulting in Shingles. While the exact trigger is still unknown, there has been a vaccine against Shingles for over ten years - however, being a live vaccine, it was previously unavailable to those on biologic medications.
Live vaccines are essentially highly weakened versions of the virus they are designed to prevent; they stimulate the immune system to recognize and destroy any variation of the virus encountered in the future. Biologic medications, such as TNF-inhibitors, suppress immune system activity. The combination of a live viral vaccine agent and the suppressed immune system brought on by biologic medication results in a sudden surge in infection susceptibility, and a potentially dangerous situation for the patient.
As of October 20, 2017, a new non-live vaccine for Shingles is approved and available for general use. This new vaccine, developed by GlaxoSmithKline and called Shingrix, is not only safe for those taking biologics, but has been proven to be much more effective than its predecessor, preventing Shingles in 97% of individuals aged 50-69 and in 91% of individuals aged 70 and above. For comparison, the previous Shingles vaccine, Zostavax, is 70% effective for individuals in their 50’s, 64% effective for individuals in their 60’s, and only 41% effective for those in their 70’s. In addition to Shingrix’s increased effectiveness, it has also shown to decrease the long term side effects of Shingles by preventing the perpetual nerve pain that can remain even after symptoms have receded.
The approval of Shingrix is an important development for spondyloarthritis patients. Despite being more expensive than Zostavax, it’s higher efficacy and usability among biologic users means that patients now have access to an illness prevention that was previously inaccessible - an undoubtedly invaluable compromise.
Sources and Further Reading
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