关于炎性关节炎患者使用Shingrix疫苗以及带状疱疹后心血管事件风险的真实世界数据。

Real-world data on the use of the Shingrix vaccine among patients with inflammatory arthritis and risk of cardiovascular events following herpes zoster.

作者信息

Curtis Jeffrey R, Conrad Danielle M, Krueger Whitney S, Gara Andrew P, Winthrop Kevin L

机构信息

Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA.

AbbVie Inc., North Chicago, IL, USA.

出版信息

Arthritis Res Ther. 2025 May 17;27(1):108. doi: 10.1186/s13075-025-03565-0.

DOI:10.1186/s13075-025-03565-0

PMID:40382657

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12085024/

Abstract

BACKGROUND

Risk of cardiovascular events may increase after herpes zoster; therefore, American College of Rheumatology guidelines strongly recommend vaccination against herpes zoster in patients aged ≥ 18 years with rheumatic and musculoskeletal diseases taking immunosuppressive medications. Here, we investigated the effectiveness of Shingrix among patients with inflammatory arthritis and estimated the post-herpes zoster risk of cardiovascular events.

METHODS

In this retrospective observational cohort study, data were obtained from the Optum™ Clinformatics™ Data Mart on patients aged ≥ 18 years with rheumatoid arthritis, psoriatic arthritis, or axial spondyloarthritis. The proportions of patients receiving any Shingrix dose, a second dose, and a second dose within 6, 9, and 12 months were calculated. Incidence of herpes zoster following inflammatory arthritis diagnosis was reported. Vaccine effectiveness was calculated as (1 - incidence rate ratio of herpes zoster) × 100. Relative risk of cardiovascular events was assessed independently in the 30-, 45-, 60-, and 90-day periods post-herpes zoster in a subgroup of patients who experienced cardiovascular events.

RESULTS

The final cohort included 132,672 patients with inflammatory arthritis. Mean age was 60.4 years, 71.9% were female, and 80.0% were diagnosed with rheumatoid arthritis. Overall, 28,690 (21.6%) patients received ≥ 1 Shingrix dose, of whom only 73.2% received a second dose. Of those receiving a second dose, 17,598 (83.8%) received it within the recommended 2-6 months after the first. Herpes zoster occurred in 4,342 (3.3%) patients, of which 360 cases occurred after Shingrix vaccination. The incidence rate (95% confidence interval) of herpes zoster per 1,000 person-years was 7.41 (6.64, 8.17) after any Shingrix vaccination vs. 14.76 (14.30, 15.22) without vaccination (crude vaccine effectiveness: 50%). The risk of venous thromboembolic events was elevated in the 60-90 days post-herpes zoster; no significantly increased risk was observed for any other cardiovascular events.

CONCLUSIONS

This study showed that the effectiveness of Shingrix in patients with inflammatory arthritis on immunomodulatory treatment was 50%, and the risk of venous thromboembolic events was increased in the 60-90 days after herpes zoster, supporting the recommendation that adults with inflammatory arthritis should receive vaccination against herpes zoster to reduce the risk of such events.

摘要

背景

带状疱疹后心血管事件风险可能增加；因此，美国风湿病学会指南强烈建议，年龄≥18岁且患有风湿和肌肉骨骼疾病并正在服用免疫抑制药物的患者接种带状疱疹疫苗。在此，我们调查了Shingrix（重组带状疱疹疫苗）在炎性关节炎患者中的有效性，并估计了带状疱疹后心血管事件的风险。

方法

在这项回顾性观察性队列研究中，数据来自Optum™ Clinformatics™ 数据集市，研究对象为年龄≥18岁的类风湿关节炎、银屑病关节炎或中轴型脊柱关节炎患者。计算接受任何一剂Shingrix、第二剂以及在6、9和12个月内接受第二剂的患者比例。报告炎性关节炎诊断后带状疱疹的发病率。疫苗有效性计算为（1 - 带状疱疹发病率比）×100。在发生心血管事件的患者亚组中，独立评估带状疱疹后30天、45天、60天和90天内心血管事件的相对风险。

结果

最终队列包括132,672例炎性关节炎患者。平均年龄为60.4岁，71.9%为女性，80.0%被诊断为类风湿关节炎。总体而言，28,690例（21.6%）患者接受了≥1剂Shingrix，其中只有73.2%接受了第二剂。在接受第二剂的患者中，17,598例（83.8%）在第一剂后的推荐2 - 6个月内接受了第二剂。4,342例（3.3%）患者发生了带状疱疹，其中360例发生在接种Shingrix疫苗后。每1000人年中，接种任何一剂Shingrix后带状疱疹的发病率（95%置信区间）为7.41（6.64，8.17），未接种疫苗时为14.76（14.30，15.22）（粗疫苗有效性：50%）。带状疱疹后60 - 90天内静脉血栓栓塞事件的风险升高；未观察到任何其他心血管事件风险有显著增加。