Reduced Shingrix Vaccine Response in Systemic Sclerosis Patients, finds study

A new study published in the journal of Rheumatology showed that compared to healthy persons, patients with systemic sclerosis (SSc) had a reduced immune response to the recombinant herpes zoster vaccine (RZV).

Patients with SSc, a complicated inflammatory condition that frequently necessitates immunosuppressive therapies, are particularly vulnerable to viral infections like herpes zoster. To maximize prophylactic therapy for this susceptible group, this prospective review examines the safety, effectiveness, and immunogenicity of the RZV in SSc patients.

Thus, this study was to determine the factors influencing vaccine response, evaluate the humoral immune response to RZV in immunosuppressed patients with SSc when compared to healthy controls, and evaluate the safety of RZV and its impact on disease activity (DA) and patient-reported outcome measures (PROMs).

This secondary analysis included 304 healthy controls (CG) and 76 immunosuppressed patients with systemic sclerosis (SSc) who received a two-dose series of the RZV vaccination in this study. Initially, the SSc group was randomized to receive either the vaccination or a placebo; once the experiment was unblinded, the placebo recipients were switched to receive the two doses of RZV.

Anti-glycoprotein-E antibodies were measured before vaccination and six weeks after the second dose to measure immunological response. This allowed for the computation of geometric mean concentrations (GMCs) and factor increase (FI). Additionally, the research analyzed nutritional status based on body mass index (BMI), measured disease activity DA and PROMs using conventional clinical instruments, and measured cell-mediated immunogenicity (CMI).

When compared to CG, SSc patients (47.4% diffuse/52.6% limited) were younger (53.0 vs. 55.0 years, p=0.002) and had lower BMIs (p=0.005). SSc patients had a substantially lower humoral response than controls (92.6% vs. 99.7%, p=0.001).

When compared to controls, SSc patients had comparable CMI (p>0.05) but considerably lower GMC (5.81 vs. 12.6, p<0.001) and FI (31.0 vs. 59.4, p<0.001). Impaired vaccination response was not predicted by disease subtypes, demographics, immunosuppressive treatments, or nutritional condition (p>0.05).

While systemic responses were similar overall (59.2% vs. 61.5%, p=0.712), local adverse events were lower in SSc patients (73.7% vs. 86.5%, p=0.024). Results for DA and PROMs did not change (p>0.05).

Overall, RZV was well-tolerated. regarding 50% lower antibody concentrations in SS raise concerns regarding long-term protection, highlighting the need for further monitoring.

Source:

Luppino-Assad, A. P., Mello, R. P., Medeiros-Ribeiro, A. C., Aikawa, N. E., Pasoto, S. G., Praxedes, A. C., Kupa, L. V., Miossi, R., Sampaio-Barros, P. D., Borba, E. F., Bonfá, E., & Silva, C. A. (2026). Prospective evaluation of recombinant Herpes zoster vaccine in systemic sclerosis: immunogenicity, safety, and disease outcomes. Rheumatology (Oxford, England), keag294. https://doi.org/10.1093/rheumatology/keag294