Hz y pso

 STORY OF THE WEEK

Published in Dermatology

Journal Scan / Consensus and Guidelines · April 04, 2019

Herpes Zoster Incidence and Consensus Recommendations on Vaccination in Adults on Systemic Therapy for Psoriasis or Psoriatic Arthritis

Journal of the American Academy of Dermatology

BACKGROUND

Herpes zoster (HZ) incidence is linked to immunosuppression. Patients with psoriasis (PsO) and/or psoriatic arthritis (PsA) on systemic therapy may be at increased risk for HZ.

OBJECTIVE

To assess HZ risk in patients with PsO/PsA by systemic treatment and provide recommendations regarding HZ vaccination.

METHODS

A systematic literature search was performed of HZ in patients with PsO/PsA. 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.

RESULTS

41 studies met inclusion criteria. Systemic corticosteroids (strong, 1), tofacitinib (strong, 1), and combination therapy with biologic and conventional synthetic disease modifying antirheumatic drugs (weak, 2a) carry increased HZ risk while monotherapy does not. There is insufficient evidence to determine risk with interleukin 12/23, 17, and 23 inhibitors, or apremilast (weak, 2a). Recombinant zoster vaccine is recommended for all PsO/PsA patients >50 years old and to patients <50 years old on tofacitinib, systemic steroids, or combination systemic treatment. Vaccination of patients <50 years old on other systemic therapies may be considered on a case-by-case basis.

LIMITATIONS

There was significant heterogeneity between studies.

CONCLUSIONS

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

TAKE-HOME MESSAGE

• This systematic review of 41 studies assessed the risk of herpes zoster in patients with psoriasis and/or psoriatic arthritis receiving systemic treatment. Treatments that are associated with an increased herpes zoster risk include systemic corticosteroids (strong evidence), tofacitinib (strong evidence), and combination therapy with biologic and conventional synthetic disease-modifying antirheumatic drugs (weak evidence). There is insufficient evidence to evaluate the risk associated with apremilast or interleukin 12/23, 17, and 23 inhibitors.

• Recombinant zoster vaccine is recommended for all patients with psoriasis and psoriatic arthritis who are >50 years old and for younger patients at an increased risk, including those on tofacitinib, systemic steroids, or combination systemic treatment.

– InYoung Kim, MD, PhD

Journal of the American Academy of Dermatology

A Systematic Review of Herpes Zoster Incidence and Consensus Recommendations on Vaccination in Adult Patients on Systemic Therapy for Psoriasis or Psoriatic Arthritis: From the Medical Board of the National Psoriasis Foundation

J Am Acad Dermatol 2019 Mar 15;[EPub Ahead of Print], E Baumrin, A Van Voorhees, A Garg, SR Feldman, JF Merola 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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