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    Distinguished Community Member agate's Avatar
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    Default Shingles vaccine

    Shingles and the shingles vaccines have been mentioned recently here. I just ran across this in NEJM Journal Watch (November 13), in the "Summary and Comment" section. It more or less says what the doctor just told me yesterday--that side effects from the vaccine can be bad. This article seems to be saying that the side effects might be so bad that people won't want that second shot they're supposed to have.



    November 13, 2018
    Is the New Zoster Vaccine Better Than the Old One?
    Abigail Zuger, MD reviewing Tricco AC et al. BMJ 2018 Oct 25
    A meta-analysis suggests more toxicity but better efficacy from the recombinant vaccine.

    The new two-dose recombinant zoster vaccine (RZV; Shingrix) has been greeted with enthusiasm because of its impressive efficacy rates during clinical trials and its presumed safety in immunocompromised patients (NEJM JW Infect Dis Jul 2015 and N Engl J Med 2015; 372:2087).

    Still, researchers have not yet assessed RZV's performance in clinical settings or directly compared its performance with that of the older live attenuated vaccine (LAV; Zostrix).

    To compare the two vaccines indirectly, researchers conducted a meta-analysis of 27 randomized and observational studies that involved more than 2 million patients (age, >50). The investigators were able to conclude that, for preventing both suspected and confirmed herpes zoster, the performance of RZV appeared to be statistically superior to that of the LAV. For preventing ophthalmic zoster, the performance of RZV also appeared to be statistically superior to that of LAV (although the authors cautioned that the data were too sparse to call this conclusion firm). Risk for developing postherpetic neuralgia was slightly lower with RZV than with LAV.

    Adverse events, both local and systemic, were significantly more likely with RZV than LAV, but neither vaccine affected mortality. Safety and efficacy in immunocompromised patients could not be compared because of inadequate data.

    RZV certainly looks good on paper, and in theory it should be a boon to immunocompromised patients who cannot receive live vaccines. On the other hand, the toxicity of RZV, (along with the requirement for a second dose of vaccine in patients who might have had a bad experience with the first dose) is likely to limit its real-world performance. A head-to-head trial to compare RZV with LAV is ongoing and should provide interesting data.
    Last edited by agate; 11-13-2018 at 11:50 PM.
    MS diagnosed 1980. Avonex 2002-2005. Copaxone 6/07 - 5/10.
    Member of this MS board since 2001.

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