Dr Jeffrey Curtis Discusses Using Live Virus Vaccines in Immunocompromised Patients

Patients with immunosuppressive conditions, particularly those being treated with tumor necrosis factor (TNF) inhibitors, are vulnerable to infections, but rheumatologists have mostly been hesitant to use any live virus vaccines in these patients, said Jeffrey R. Curtis, MD, MS, MPH, professor of medicine in the Division of Clinical Immunology and Rheumatology at the University of Alabama at Birmingham.

Transcript

One of the big issues for patients with rheumatic diseases is that they can be immunocompromised because of the TNF inhibitors. What was the VERVE trial studying and what are the clinical implications of the findings?

So, as you’ve alluded to, patients with immunosuppressive conditions—rheumatoid arthritis, inflammatory bowel disease, psoriatic arthritis—are on a variety of immunomodulatory or immunosuppressive medications. Whether it’s those diseases, or those treatments that put people at higher risk of infection is a little bit unclear, but at the end of the day, they’re at higher risk of infection. And that’s been long recognized.

It is unfortunate if one has a vaccine to prevent those infections to not be able to use it. And yet, for well over a decade we have had a live virus vaccine, Zostavax, that is a weakened or attenuated virus that could prevent infection, but we’ve been mostly too afraid to use it in people who have immunocompromised or immune conditions or are on immunosuppressive medications.

So, the background for the VERVE trial is to test the hypothesis: Is it safe and is it effective to give a live virus vaccine to an immunocompromised patient population, which, in this case, was people using anti-TNF therapies.