Shingrix provides a pricey but welcome alternative for rheumatic disease patients.
Shingrix provides a pricey but welcome alternative for rheumatic disease patients.
Now available on the Australian market, Shingrix is a recombinant subunit adjuvanted vaccine for the prevention of herpes zoster and postherpetic neuralgia, the most common complication of shingles.
Shingrix is not currently included in the National Immunisation Program (NIP) but is available by private prescription at a cost of around $250-300 per dose, according to its manufacturer, GSK. Two doses are needed.
“It’s a great advance to have this available in Australia, considering it has been in the US for a few years. It has greater efficacy than Zostavax and is non-live, so it’s much better than our current alternative,” said Dr Laurel Young, rheumatologist and senior lecturer at the University of Queensland.
The Shringrix vaccine has been shown to be more effective than Zostavax, the live, attenuated vaccine currently listed on the NIP for the prevention of shingles in people aged 70 to 79 years.
According to a study funded by GSK, it offers 97% protection against herpes zoster for 50–59-year-olds, and 91% for those over 70. It also offers similar levels of protection against postherpetic neuralgia over more than three years.
Efficacy data on people who are immunocompromised are limited, though the vaccine appears to be safe.
As yet, Shingrix hasn’t been included on the ARA vaccination guideline for people with autoimmune inflammatory rheumatic diseases.
“It hasn’t been broadly studied in our patients,” said Dr Young, noting that more information about the impacts on patients taking DMARDs and potential reactions to the adjuvant is needed.
Dr Young said Shingrix is likely to be recommended as more information emerges about its efficacy in rheumatic patients. Cost will be an issue, she said, but some patients are likely to pay.
The live vaccine, Zostavax, is generally not recommended for significantly immunosuppressed patients due to the possibility of a vaccine-induced infection.
However, the current guideline suggests the live vaccine may be considered for patients aged 50-80 years, subject to certain restrictions relating to prior varicella infection or vaccination and medications being taken.
Current ARA guideline:
