Question
I am pharmacy student on my clinical rotation. I recently had a doctor ask me if he could give the new shingles vaccine, Zostavax to a patient of his that was on Enbrel. The vaccine is contraindicated for patients on immunosuppressant therapy. It is a live vaccine and I have been unable to find any guidelines on its use in RA patients. I think this would become an issue since the vaccine is indicated in older patients who are more likely to have problems with RA.
Answer
Your question is a good one. I am not aware of any published guidelines for RA patients specifically, but live vaccinations are contraindicated in patients on immunosuppressive therapy which would include prednisone and methotrexate in addition to the anti-TNF drugs, drugs commonly used in RA patients. RA patients off of medications are not considered immunocompromised. Now that we are in flu season, the nasal flu vaccine is also an attenuated live vaccine.
