Can Benralizumab (anti-interleukin-5 receptor alpha subunit monoclonal antibody) cause shingles, particularly in immunocompromised patients or those with a history of varicella?

Is Shingles a Side Effect of Benralizumab?

No, shingles (herpes zoster) is not a documented side effect of benralizumab based on the available evidence. The provided evidence does not contain any information linking benralizumab to increased shingles risk, and none of the guidelines, drug labels, or research studies mention benralizumab in relation to varicella-zoster virus reactivation.

Understanding the Context

The evidence provided focuses extensively on:

• Shingles management in immunocompromised patients - particularly those with HIV, cancer, or on immunosuppressive therapies 1, 2
• Specific immunosuppressive medications associated with shingles risk - including JAK inhibitors (like tofacitinib), corticosteroids, proteasome inhibitors (bortezomib), and chemotherapy agents 2, 3
• General varicella-zoster virus prevention and treatment strategies 1, 2

Key Distinction: Benralizumab's Mechanism

Benralizumab is an anti-interleukin-5 receptor alpha (anti-IL-5Rα) monoclonal antibody that specifically targets eosinophils. This mechanism differs fundamentally from the immunosuppressive agents documented to increase shingles risk in the evidence:

• JAK inhibitors (tofacitinib) are explicitly associated with increased shingles risk, with vaccination recommended before initiation 2, 3
• Corticosteroids increase shingles risk through broad immunosuppression 2, 4
• Chemotherapy agents significantly elevate risk through profound immunosuppression 2

Clinical Implications

While the evidence does not establish a connection between benralizumab and shingles:

• Patients on any biologic therapy should be assessed for varicella-zoster virus immunity status 1
• The recombinant zoster vaccine (Shingrix) is recommended for all adults aged 50 years and older regardless of medication use 2, 5
• If shingles develops in any patient (regardless of medication), prompt antiviral therapy with valacyclovir or famciclovir should be initiated within 72 hours of rash onset 2

Important Caveat

The absence of evidence in the provided materials does not definitively prove benralizumab has zero association with shingles risk. However, based on the comprehensive guidelines and research provided—which extensively cover immunosuppressive medications and shingles risk—the lack of any mention of benralizumab suggests it is not recognized as a significant risk factor for varicella-zoster virus reactivation.