Is it safe to use Shingrix (zoster vaccine recombinant) in a patient with declining renal function?

From the Guidelines

Shingrix vaccine is safe to use in patients with declining renal function, as it is a non-live recombinant zoster vaccine, making it appropriate even for immunocompromised patients, including those with renal impairment. The vaccine's safety profile is well-established, with common side effects including injection site pain, redness, and swelling, as well as systemic reactions like fatigue, muscle pain, headache, and fever, which typically resolve within 2-3 days 1. Although the provided evidence does not directly address the use of Shingrix in patients with declining renal function, it does mention the importance of vaccination with zoster vaccine (Shingrix) to reduce the risk of herpes zoster in patients taking tofacitinib, a medication that can be used in patients with moderate and severe renal impairment 1. The benefits of preventing herpes zoster (shingles) and its complications, particularly postherpetic neuralgia, often outweigh the temporary discomfort from vaccination. Key considerations for healthcare providers include:

• Assessing the patient's overall prognosis, goals of care, and ability to complete the two-dose series
• Evaluating the patient's immune system function and potential interactions with other medications
• Monitoring for potential side effects and adjusting treatment as needed
• Weighing the benefits of vaccination against the risks of herpes zoster and its complications in patients with declining renal function.

From the Research

Safety of Shingrix in Patients with Declining Renal Function

• There are no direct studies provided that assess the safety of Shingrix (zoster vaccine recombinant) in patients with declining renal function 2, 3, 4, 5, 6.
• The provided studies discuss the efficacy and safety of Shingrix in general populations, including immunocompetent adults and those with autoimmune or immunosuppressive conditions 2, 3, 4.
• However, none of the studies specifically address the use of Shingrix in patients with declining renal function.
• As a result, there is no clear evidence to confirm the safety of Shingrix in this specific population 2, 3, 4, 5, 6.

Relevant Populations Studied

• The studies provided discuss the use of Shingrix in various populations, including:
  • Immunocompetent adults aged ≥50 years 2, 3, 4
  • Adults with autoimmune or immunosuppressive conditions 2, 3
  • Older adults, with a focus on those aged ≥65 years 2
• However, patients with declining renal function are not specifically mentioned in the provided studies 2, 3, 4, 5, 6.

Lack of Direct Evidence

• Due to the absence of direct evidence, it is not possible to determine the safety of Shingrix in patients with declining renal function based on the provided studies 2, 3, 4, 5, 6.