The National Psoriasis Foundation’s medical board is recommending the recombinant zoster vaccine for all patients with psoriasis or psoriatic arthritis who are older than 50 years or whose treatment puts them at increased risk for herpes zoster.
The consensus recommendations, published online in the Journal of the American Academy of Dermatology, were based on findings from a systematic review of herpes zoster incidence in patients with psoriasis or psoriatic arthritis.
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“Herpes zoster incidence is linked to immunosuppression,” the researchers wrote. “Patients with psoriasis and/or psoriatic arthritis on systemic therapy may be at increased risk for herpes zoster.”
The medical board’s review of 41 studies found strong evidence that systemic corticosteroids as well as tofacitinib increase herpes zoster incidence in patients. Although it was weaker, evidence also suggested higher herpes zoster risk with combination therapy involving biologic and conventional synthetic disease modifying antirheumatic drugs.
Monotherapy does not appear to increase risk for herpes zoster, researchers reported, while evidence was insufficient to determine whether IL-12/23, IL-17, and IL-23 inhibitors, or apremilast (Otezla), influence risk.
“Recombinant zoster vaccine is recommended for all psoriasis or psoriatic arthritis patients >50 years old and to patients <50 years old on tofacitinib, systemic steroids, or combination systemic treatment,” researchers wrote. “Vaccination of patients <50 years old on other systemic therapies may be considered on a case-by-case basis.”
Baumrin E, Van Voorhees A, Garg A, Feldman SR, Merola JF. A systematic review of herpes zoster incidence and consensus recommendations on vaccination in adult patients on systemic therapy for psoriasis or psoriatic arthritis: From the Medical Board of the National Psoriasis Foundation [published online March 15, 2019]. J Am Acad Dermatol. doi:10.1016/j.mayocp.2017.10.009.