From the Guidelines
Patients on Entyvio (natalizumab) should not receive the live-attenuated shingles vaccine, but can receive the non-live recombinant Shingrix vaccine, which is considered safe for immunocompromised patients. The most recent and highest quality study 1 recommends Shingrix as the preferred option for preventing herpes zoster and postherpetic neuralgia in adults, including those who are immunocompromised. This study found that Shingrix has a higher efficacy and longer duration of protection compared to the live-attenuated Zostavax vaccine.
The 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host 1 states that Zostavax should not be administered to highly immunocompromised patients, which would include those on natalizumab. In contrast, the 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases 1 suggests that the non-live recombinant Shingrix vaccine may be a suitable option for immunocompromised patients.
Key points to consider:
- Shingrix is a non-live recombinant vaccine, making it a safer choice for immunocompromised patients
- Zostavax is a live-attenuated vaccine and should be avoided in patients on immunosuppressive medications like natalizumab
- Patients should consult their healthcare provider to coordinate optimal timing of vaccination within their treatment plan
- The most recent and highest quality study 1 supports the use of Shingrix in immunocompromised patients, including those on biologics like natalizumab.
From the Research
Shingles Vaccine and Entyvio (Natalizumab)
- Patients on Entyvio (natalizumab) can receive the shingles vaccine, specifically the recombinant zoster vaccine (RZV) 2, 3, 4.
- RZV is a non-replicating vaccine, making it safe for immunocompromised individuals, including those on immunosuppressive therapies like natalizumab 2, 4.
- The Advisory Committee on Immunization Practices (ACIP) recommends RZV for adults aged ≥19 years who are or will be immunodeficient or immunosuppressed due to disease or therapy 3.
- Studies have shown that RZV is effective in preventing herpes zoster and related complications in immunocompromised individuals, including those with immune-mediated diseases 2, 5, 4.
Key Considerations
- The recombinant zoster vaccine (RZV) is preferred over the live-attenuated zoster vaccine for immunocompromised individuals, including those on natalizumab 3, 4.
- While rare, breakthrough cases of herpes zoster can occur after RZV administration, even in immunocompromised individuals 5.
- Clinicians should be aware of the potential for post-vaccination varicella-zoster virus (VZV) infection or reactivation, although this appears to be rare 6.