Safety of Shingrix Vaccine with Humira and Hydroxychloroquine
Shingrix (recombinant zoster vaccine) is safe to administer to patients taking Humira (adalimumab) and hydroxychloroquine because it is a non-live recombinant subunit vaccine specifically designed to be safe for immunocompromised patients.
Vaccine Type and Safety Profile
- Shingrix is a recombinant zoster vaccine (RZV) containing the varicella zoster virus glycoprotein E antigen and the AS01B adjuvant system 1
- As a non-live recombinant subunit vaccine, Shingrix:
Safety with Immunomodulatory Medications
- Unlike live vaccines (such as Zostavax), which are contraindicated in immunosuppressed patients including those on biologic therapies like Humira, Shingrix is considered safe 2
- The American College of Rheumatology guidelines strongly recommend vaccination against herpes zoster in patients aged ≥18 years with rheumatic and musculoskeletal diseases taking immunosuppressive medications 3
- Real-world data shows Shingrix has approximately 50% effectiveness in patients with inflammatory arthritis on immunomodulatory treatments 3
Administration Considerations
- Shingrix is administered as a 2-dose series with an interval of 2-6 months between doses 4
- If the second dose is delayed beyond 6 months, effectiveness is not significantly impaired 5
- Common side effects include:
- Injection site pain (22.5%)
- Injection site erythema (20.1%)
- Fever (23.6%) 4
- Most reactions are transient and mild to moderate in severity 1
Special Considerations for Patients on Immunomodulatory Therapy
- For optimal immune response, consider timing vaccination:
- Ideally administer when disease activity is well-controlled
- No need to withhold hydroxychloroquine or adalimumab before or after vaccination
- Monitor for disease flares, though these are not commonly reported
Efficacy in Immunocompromised Populations
- While efficacy may be somewhat reduced in immunocompromised patients compared to healthy individuals, Shingrix still provides significant protection:
Potential Pitfalls and Caveats
- Higher reactogenicity compared to other vaccines:
- About 17% of recipients experience grade 3 reactions (symptoms that interfere with normal activity) 4
- Consider administering when the patient has no major commitments for 2-3 days after vaccination
- Preemptive use of acetaminophen may help manage post-vaccination symptoms
- Ensure completion of the two-dose series for optimal protection, as single-dose effectiveness is significantly lower 5
In summary, Shingrix is safe and recommended for patients on Humira and hydroxychloroquine, with no need to modify or interrupt these medications for vaccination.