Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar;97(3):e70285.
doi: 10.1002/jmv.70285.

Recombinant Zoster Vaccine Reduces All-Cause Mortality, But Not Major Adverse Cardiovascular Events, in Patients With Immune-Mediated Inflammatory Diseases Receiving Janus Kinase Inhibitors: A Large-Scale Real-World Retrospective Cohort Study

Po-Cheng Shih  1   2 , Shiow-Ing Wang  1   3 , Pui-Ying Leong  1   4   5 , An-Ping Huo  1   4 , James Cheng-Chung Wei  1   4   5   6   7   8   9
Affiliations

Recombinant Zoster Vaccine Reduces All-Cause Mortality, But Not Major Adverse Cardiovascular Events, in Patients With Immune-Mediated Inflammatory Diseases Receiving Janus Kinase Inhibitors: A Large-Scale Real-World Retrospective Cohort Study

Po-Cheng Shih et al. J Med Virol. 2025 Mar.

Abstract

This study aims to assess the impact of recombinant zoster vaccine (RZV) on the risk of major cardiovascular events (MACE) in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), or psoriatic diseases who are receiving Janus kinase inhibitors (JAKi). We conducted a new user design study utilizing the TriNetX database. We identified patients diagnosed with RA, SpA, or psoriatic diseases receiving JAKi. Two cohorts were constructed based on RZV vaccination status. Propensity score matching was performed. The primary outcome was MACE, analyzed using Cox regression with hazard ratios (HR) and Kaplan-Meier plots. Subgroup analyses were performed by age, sex, race, and zoster history. Sensitivity analyses were conducted with different follow-up periods and diseases. Of the 1 528 771 eligible patients initially included, each cohort included 1756 patients after propensity score matching. No significant difference in MACE risk was observed between the two cohorts (HR 1.121, 95% CI: 0.901-1.395). Subgroup and sensitivity analyses were consistent with the main findings. However, RZV vaccination was associated with a significant reduction in all-cause mortality (HR 0.610, 95% CI: 0.427-0.870). Subgroup analyses indicated that the mortality benefit was particularly evident in females (HR 0.585, 95% CI: 0.379-0.901) and those aged 65 years and older (HR 0.500, 95% CI: 0.301-0.806). In patients with immune-mediated inflammatory diseases receiving JAKi, RZV vaccination is associated with a 39% reduction in all-cause mortality compared to unvaccinated individuals. RZV vaccination should be considered for this high-risk population.

Keywords: cardiovascular; immune‐mediated inflammatory diseases; mortality; zoster vaccine.

PubMed Disclaimer

References

    1. G. I. Parameswaran, B. A. Wattengel, H. C. Chua, et al., “Increased Stroke Risk Following Herpes Zoster Infection and Protection With Zoster Vaccine,” Clinical Infectious Diseases 76, no. 3 (2023): e1335–e1340.
    1. S. G. Curhan, K. Kawai, B. Yawn, K. M. Rexrode, E. B. Rimm, and G. C. Curhan, “Herpes Zoster and Long‐Term Risk of Cardiovascular Disease,” Journal of the American Heart Association 11, no. 23 (2022): e027451.
    1. M. F. Helm, P. A. Khoury, M. Warne, et al., “Zoster Vaccine Lowers Stroke and Myocardial Infarction Risk in Chronic Disease,” American Journal of Preventive Medicine 67 (2024): 676–683.
    1. L. H. Calabrese, F. Xie, H. Yun, et al., “Herpes Zoster and the Risk of Stroke in Patients With Autoimmune Diseases,” Arthritis & Rheumatology (Hoboken, N.J.) 69, no. 2 (2017): 439–446.
    1. V. Furer, C. Rondaan, M. W. Heijstek, et al., “2019 Update of EULAR Recommendations for Vaccination in Adult Patients With Autoimmune Inflammatory Rheumatic Diseases,” Annals of the Rheumatic Diseases 79, no. 1 (2020): 39–52.

MeSH terms

LinkOut - more resources