Timing of shingles vaccine and JAK inhibitor initiation can affect early outcomes in patients with rheumatoid arthritis

A randomized trial in patients with rheumatoid arthritis (RA) suggests that the timing of when a Janus kinase (JAK) inhibitor is initiated relative to administration of the shingles vaccine can affect early immune response to shingles and arthritis control.

Because JAK inhibitors are associated with an increased risk for shingles, the findings suggest that clinicians should consider the relative urgency of RA disease control and the risk for shingles in patients considering vaccination. The study is published in Annals of Internal Medicine.

Researchers at Keio University School of Medicine and colleagues studied 59 adults ages 50 and older with RA at 12 sites in Japan. All participants received the shingles vaccine at the start of the study and again eight weeks later.

They were randomly assigned to either start the JAK inhibitor tofacitinib at the same time as the first vaccine dose or wait until the second dose. Over 12 weeks, researchers tracked immune response, arthritis symptoms, and side effects. Patients who delayed the drug had a stronger early immune response to the vaccine, while those who started the drug right away saw quicker relief from arthritis symptoms. By the end of the study, however, both groups had similar immune responses, that JAK inhibitor use may delay but does not prevent vaccine induced immunity.

Reference:

Satoshi Takanashi, Koichiro Ohmura, Shuji Sumitomo, et al. Timing of Recombinant Herpes Zoster Virus Vaccination Administration and JAK Inhibitor Initiation in Rheumatoid Arthritis: A Multicenter, Open-Label, Randomized Comparative Study. Ann Intern Med. [Epub 21 July 2026]. doi:10.7326/ANNALS-25-05493