The Impact of Reactogenicity After the First Dose of Recombinant Zoster Vaccine on the Physical Functioning and Quality of Life of Older Adults: An Open-Label, Phase III Trial

Abstract

Background: Herpes zoster and its related complications are associated with significant medical burden, which negatively affects quality of life and daily functioning of the patients. The recently licensed recombinant zoster vaccine (RZV) offers high efficacy but is associated with local and systemic reactions. This study assessed the impact of RZV on the quality of life and daily functioning of participants and implications for caregivers.

Methods: Four hundred and one adults aged 50 years or older received single RZV doses at 0 and 2 months in this open-label, single-arm, multicenter study (NCT02979639). Change in mean SF-36 Physical Functioning score following first-dose administration, quality of life, reactogenicity, safety, productivity loss, and health care resource utilization was assessed. The current analysis was performed post-vaccine dose-1; safety follow-up will continue until 1 year post-dose-2.

Results: The most common solicited local symptoms were injection-site pain (77.5%), redness (23.0%), and swelling (13.3%); the most frequent solicited systemic reactions were fatigue (33.5%), headache (28.3%), and myalgia (26.8%). Grade 3 reactogenicity occurred in 9.5% of participants and was associated with a transient clinically important decrease in SF-36 Physical Functioning score (affecting activities such as walking, carrying groceries, climbing stairs) on Days 1 and 2 post-first vaccination. No clinically meaningful reductions in mean SF-36 Physical Functioning scale scores from pre- to post-RZV dose-1 were observed (mean +1.9 points, primary end point), and no overall quality-adjusted-life-year loss was recorded post-dose-1. Five participants reported lost workdays; caregiver workload was not increased.

Conclusions: Overall, the physical functioning and quality of life of older adults were not affected by a first RZV dose. The observed reactogenicity was consistent with previous studies.

Keywords: Pain; Physical activity; Physical function; RZV.

Figure 1.

Percentage of participants with solicited systemic symptoms before vaccination and solicited local and systemic symptoms over Days 0–6 post-first vaccination^a (Total Vaccinated Cohort). ^aRecombinant zoster vaccine Dose 1 administered on Day 0. *Nausea, vomiting, diarrhea, and/or abdominal pain; **≥37.5°C. GI = gastrointestinal.

Figure 2.

Mean SF-36 Physical Functioning scale score pre- and post-first vaccination^a by age and overall (Total Vaccinated Cohort). ^aRecombinant zoster vaccine Dose 1 administered on Day 0.

Figure 3.

Mean SF-36 Physical Functioning single items from Day −7^a to Day 7 for participants with Grade 3 reactogenicity only (Total Vaccinated Cohort). ^aRecombinant zoster vaccine Dose 1 administered on Day 0.

Figure 4.

Mean EQ-5D utility score from Day −7^a to Day 7 by reactogenicity grade (Total Vaccinated Cohort). ^aRecombinant zoster vaccine Dose 1 administered on Day 0.

Figure 5.

Focus on the Patient section.