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New zoster vaccine prevents more cases, but causes more sore arms
Clinical Question
Which herpes zoster vaccine is more effective?
Bottom line
The adjuvant recombinant subunit version (Shingrix) of the herpes zoster vaccine is much more effective than the live attenuated version (Zostavax). There's more to the story, however: Shingrix is much more likely to cause injection site pain. Unlike the live version, it requires 2 doses and—although not demonstrated in the trials—a few days of acute arm soreness might limit patients' enthusiasm for the required second dose, and both doses are required for an adequate immune response. 1a
Reference
Study design: Meta-analysis (other)
Funding: Government
Setting: Various (meta-analysis)
Synopsis
These researchers searched several databases, including the Cochrane Library, as well as trial registries and reference lists. They assembled 27 studies, mostly randomized controlled trials, that compared the effects of herpes zoster vaccination. The studies, ranging in size from 54 to 766,380 patients, comprised a total of more than 2 million patients. They used a network meta-analysis, which allowed them to compare the 2 forms of the vaccine against each other even though they weren't directly compared. Using this method of analysis, the live attenuated version did not decrease the likelihood of confirmed herpes zoster any more than placebo. However, the subunit vaccine was markedly more effective than both placebo and the live attenuated version (vaccine efficacy 85% vs the live version and 94% vs placebo). Not without cost, though: The subunit vaccine was almost twice as likely as the live version to cause injection site reactions and more likely than placebo to cause systemic adverse effects.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA
Comments
NNT please
With all these studies could we please get an updated age based incident rate for zoster with ARR, NNT & NNH so we can have data informed discussions with patients so they can decide?
Informative
Informative