Herpes and MS: Some questions still unanswered
“We’ve known that herpes zoster is more common in people with MS, and we’ve known that it is seen in people on MS therapies,” Robert Fox, MD, a staff neurologist at the Mellen Center for MS and vice-chair for research at the Neurological Institute at the Cleveland Clinic, said in an interview. “What we haven’t known is just how much more common it is in people with MS than the rest of the adult population and whether it truly is more common in people taking MS therapies than people not taking MS therapies. This study puts real, population-based numbers on the incidence rates.”
Dr. Fox, who was not involved in the research, noted that a limitation of the study was the inability to know the risk of shingles according to specific MS therapies since all the therapies were grouped together.
”So I can’t say to a patient that their particular therapy increases their risk,” Dr. Fox said. “Similarly with the MS therapies listed in the ‘high’ immunosuppression category: We don’t know that each of the therapies listed do in fact increase the rate of herpes zoster. We just know that the group of MS therapies bunched into the ‘high’ category, on the whole, increase the rate of herpes zoster.”
The study does not provide any information about the impact of Shingrix vaccination, he added, since vaccinated individuals were excluded from the analysis.
Timing the vaccination with MS therapy
Dr. Steinman said in an interview that he recommends herpes zoster vaccination to his patients with MS.
“The mistake that people make with MS is that they don’t want to take the [herpes zoster] vaccine, and they should be taking it,”
Dr. Steinman said. “In a perfect world, they would get it before they went on their [immunosuppressive] drug. But now we’ll have a lot of people who didn’t take the vaccine; they can get it while they’re on their drug.” Although it depends on the particular therapy they’re taking, Dr. Steinman said that most people can get the shingles vaccine while continuing their medication.
The Centers for Disease Control and Prevention recommends that adults who are or will be immunodeficient or immunosuppressed because of a disease or therapy get two doses of the Shingrix vaccine against herpes zoster, regardless of whether they have previously been vaccinated with Zostavax or have ever had shingles. The agency has also issued detailed clinical guidance regarding how to administer the vaccine to individuals taking immunosuppressive therapy, including the option to administer the second dose 1-2 months after the first instead of 2-6 months to “facilitate avoiding vaccination during periods of more intense immunosuppression,” the agency wrote.
The research was sponsored, funded, and analyzed by GSK, which manufactures the shingles vaccine Shingrix, and Mr. Stempniewicz is a GSK employee. Two other authors are GSK employees, and three authors are employees of Optum who received fees from GSK for this study. Dr. Steinman and Dr. Fox reported no relevant disclosures.