Timing of Entyvio After Shingrix Vaccination
You can start Entyvio (vedolizumab) 2 weeks after completing the Shingrix vaccination series, though ideally both doses of Shingrix should be administered before initiating biologic therapy. 1
Recommended Timing Algorithm
Ideal Scenario (Non-Urgent Biologic Initiation)
- Administer the first dose of Shingrix immediately 1
- Wait 2-6 months and give the second Shingrix dose 2
- Wait a minimum of 2 weeks after the second dose before initiating Entyvio 1
- This approach maximizes immune response while the patient is not yet immunosuppressed 1
Urgent Biologic Initiation Required
- Administer at least the first Shingrix dose 1
- Wait 2 weeks after the first dose 1
- Start Entyvio therapy 1
- Complete the second Shingrix dose 1-2 months later while on Entyvio (though immune response may be somewhat reduced) 1
Key Clinical Rationale
The 2-week waiting period reflects Shingrix's non-live recombinant composition and allows adequate immune response before starting immunosuppressive therapy. 1 This shorter interval is fundamentally different from the 4-week waiting period recommended for live vaccines, which does not apply to Shingrix. 1
Why Shingrix Before Biologics Matters
- Shingrix is a recombinant (non-live) vaccine, making it safe for immunocompromised patients unlike the older live-attenuated Zostavax 1, 3
- The vaccine can be safely administered to patients already on biologic therapy, though ideally given before initiation 1
- Patients with inflammatory bowel disease on immunosuppressive therapy are at higher risk of infectious diseases, making vaccination particularly important 3
Important Caveats and Pitfalls
Never confuse the 4-week waiting period for live vaccines with the 2-week period for Shingrix - this is a critical distinction that could lead to unnecessary treatment delays. 1 The British Society of Gastroenterology's 4-week recommendation applies specifically to live vaccines, not recombinant vaccines like Shingrix. 1
Never use live-attenuated Zostavax in patients about to start or currently on biologics - only Shingrix is appropriate for this population. 1, 4
Dosing Schedule Flexibility
- The minimum interval between Shingrix doses is 4 weeks, though 2-6 months is recommended 2
- For immunocompromised adults aged ≥18 years, a shorter schedule with the second dose given 1-2 months after the first dose may be considered 2
- Second doses administered beyond 6 months maintain full effectiveness and do not impair protection 5
Special Considerations for IBD Patients
- Shingrix demonstrates 50% vaccine effectiveness in patients with inflammatory arthritis on immunomodulatory treatment, supporting vaccination in immunosuppressed populations 6
- The vaccine maintains effectiveness even in patients on immunosuppressive therapy, though immune response may be somewhat reduced compared to healthy individuals 2
- Injection-site reactions and systemic symptoms are common but typically resolve within 4 days 7