AbstractBackground and AimsOlder patients with ulcerative colitis treated with tofacitinib are at risk for major cardiovascular events, thromboembolism, herpes zoster, and malignancies and, accordingly, its use is limited by the regulatory authorities. The aim of the present study was to evaluate the occurrence of adverse events and potential preventive measures.MethodsWe retrospectively evaluated patients treated with tofacitinib, divided into two groups according to comorbidities and age. Patient- and disease-related variables were recorded [primary non-response, loss of response, and persistence], together with deviations from the recommended induction regimen, ie, dose reduction, and concomitant treatments with anti-thrombotic therapy.ResultsThe age-adjusted Charlson comorbidity index of Group 1 [n = 30] was ≥2 and that of Group 2 [n = 37] was ≤ 1. No differences were observed for primary or secondary treatment failures. Both groups achieved comparable steroid-free remission rates at 12 months [53% and 46%, respectively]. Herpes zoster occurred in two patients per group, and no more cases occurred after strict recombinant zoster vaccination. No major cardiovascular event or thromboembolism was registered. Half of patients in Group 1 were treated with a reduced induction dose of 5 mg twice daily and 47% were on concomitant anti-thrombotic therapy. Malignancies were registered in two patients from Group 1 and one patient from Group 2.ConclusionsModulation of induction dose and anti-thrombotic therapy may have contributed to prevent cardiological events and thromboembolism. The introduction of zoster vaccine virtually eliminated zoster risk after the first cases. Potential malignancies deserve a careful work-up of older patients before treatment start.

2023-12-01·Journal of Drugs in Dermatology

Recombinant Zoster Vaccine Reduces 3-Year Cardiovascular Risk: Insights From a Multi-Centered Database

Article

作者: Raiker, Rahul ; Helm, Matthew F ; Pakchanian, Haig ; Maczuga, Steven ; Khoury, Peter A ; Foulke, Galen T

BACKGROUNDHerpes zoster increases the risk for stroke and myocardial infarction. Zoster vaccination's impact on this risk is understudied. This retrospective work sought to determine if prophylactic herpes zoster vaccination may reduce the risk of stroke, myocardial infarction, and/or mortality.METHODSA cohort analysis utilized TriNetX, a national, federated database. In one analysis, patients who received 2 doses of recombinant zoster vaccine (RZV) were compared to adults without RZV. A 1:1 propensity-score match analysis was conducted to adjust for demographics and comorbidities in calculating adjusted relative risks (aRR) with 95% confidence intervals. First-time incidences for myocardial infarction, stroke, and mortality were assessed after 3 years. A subgroup analysis between RZV and zoster vaccine live (ZVL) was also assessed.RESULTSMatched cohorts of 7,657 patients revealed that adults who received 2 doses of RZV were at lower risk of MI (aRR [95% CI]) = (0.73 [0.55, 0.96]) and mortality (0.7 [0.57, 0.88]) while having similar risk for stroke (0.97 [0.75, 1.26]). Further subgroup analysis also revealed a reduced risk of 3-year mortality when compared to the ZVL cohort (0.84 [0.74, 0.95]). Sample size and comorbidities included in the analysis were limited by using a large database.CONCLUSIONSRZV reduces the 3-year risk for myocardial infarction and mortality. J Drugs Dermatol. 2023;22(12):1178-1182. doi:10.36849/JDD.7415.

2023-07-01·Clinical Microbiology and Infection

Clinical effectiveness of zoster vaccine live in kidney transplant recipients immunized prior to transplantation: a retrospective single-centre cohort study

Article

作者: Cho, Sun Young ; Huh, Woo Seong ; Chung, Doo Ryeon ; Lee, Kyo Won ; Ko, Jae-Hoon ; Kang, Cheol-In ; Peck, Kyong Ran ; Huh, Kyungmin ; Park, Jae Berm ; Kim, Si-Ho

OBJECTIVESKidney transplant (KT) recipients have an increased risk of herpes zoster (HZ) and its complications. Although recombinant zoster vaccine is favoured over zoster vaccine live (ZVL), ZVL is also recommended to prevent HZ for KT candidates. We aimed to evaluate the clinical effectiveness of ZVL in KT recipients immunized before transplantation.METHODSAdult patients who received kidney transplantation from January 2014 to December 2018 were enrolled. Patients were observed until HZ occurrence, death, loss of allograft, loss to follow-up, or 5 years after transplantation. The inverse probability of the treatment-weighted Cox proportional hazard model was used to compare the incidence of HZ after transplantation between vaccinated and unvaccinated patients.RESULTSA total of 84 vaccinated and 340 unvaccinated patients were included. The median age was higher in the vaccinated group (57 vs. 54 years, p 0.003). Grafts from deceased donors were more frequently transplanted in the unvaccinated group (16.7% vs. 51.8%, p < 0.001). Five-year cumulative HZ incidence was 11.9%, which translated to 26.27 (95% CI, 19.33-34.95) per 1000 person-years. The incidence in the vaccinated and unvaccinated groups was 3.9% and 13.7%, respectively. After adjustment, vaccination showed significant protective effectiveness against HZ (adjusted hazard ratio, 0.18, 95% CI, 0.05-0.60). In addition, all four cases of disseminated zoster occurred in the unvaccinated group.DISCUSSIONOur study, the first on the clinical effectiveness of zoster vaccines for KT recipients, suggests that ZVL before transplantation effectively prevents HZ.

100 项与带疱疫苗((Boaovax Biotechnology) 相关的药物交易

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