Differences in immunogenicity to zoster recombinant vaccine in IMID patients undergoing treatment with non-selective or selective JAK-i
Authors' conclusion
Our study highlights impaired immune responses to the recombinant herpes zoster vaccine in IMID patients treated with JAK-is.
Study context
- Population
- IMID patients treated with JAK-i or anti-TNF and/or MTX receiving a two-dose recombinant zoster vaccine (mean age 58.6 ± 9.9 years; 33% female)
- Participants
- 176 patients
- Exposure
- JAK-i vs anti-TNF and/or MTX vs healthy controls
- Non-selective Janus kinase inhibitors (JAK-is)n = 39
- Upadacitinibn = 54
- anti-TNF/MTXn = 46
- Controlsn = 37reference
- Outcome
- Humoral (seroconversion, varicella zoster virus (VZV)-specific IgG titer) and cellular (CD4 IL-2 plus IFN-γ; CD8 Granzyme A and/or B) immune responses after two-dose recombinant zoster vaccine
Methodological detailshealthy controls matched by age and sex
- Healthy controls matched by age and sex
Main finding
As reported in the abstract
Seroconversion
P < 0.001
Observational data: associations, not effects.
Further findings
| Outcome | Values | P value |
|---|---|---|
| Post-vaccination IgG titerJAK-i vs anti-TNF/MTX · across three groups | JAK-i Median 1753 ± 1112 mIU/ml · anti-TNF/MTX Median 2874 ± 1020 mIU/ml · Controls Median 3185 ± 576 mIU/ml | P < 0.001 |
| CD4 Th1 responses (IL-2 + IFN-γ)JAK-i vs anti-TNF/MTX · across three groups | JAK-i 28% · anti-TNF/MTX 67% · Controls 95% | P < 0.001 |
| CD8 T cell responsesJAK-i vs anti-TNF/MTX · across three groups | JAK-i 29% · anti-TNF/MTX 41% · Controls 85% | P < 0.001 |
| Responses by JAK-i: baricitinib vs upadacitinib (seroconversion; CD4; CD8) | Upadacitinib 83% · CD4 39% · CD8 39% |
- Responses by JAK-i: baricitinib vs upadacitinib (seroconversion; CD4; CD8) — Baricitinib seroconversion
- 64%
- Responses by JAK-i: baricitinib vs upadacitinib (seroconversion; CD4; CD8) — Baricitinib CD4
- 0%
- Responses by JAK-i: baricitinib vs upadacitinib (seroconversion; CD4; CD8) — Baricitinib CD8
- 7%
Responses by JAK-i: baricitinib vs upadacitinib (seroconversion; CD4; CD8)
- Non-selective JAK-is associated with the poorest responses
Granzyme A/B, IL-2 and IL-6 post-vaccination
- Significantly higher in anti-TNF/MTX than in JAK-i groups
Factors associated with immunogenicity
- Negative correlation with cumulative GC and MTX doses, longer JAK-i exposure and history of ≥2 DMARDs
Original publication
Differences in immunogenicity to zoster recombinant vaccine in IMID patients undergoing treatment with non-selective or selective JAK-i. Rheumatology (Oxford). Published 16 October 2025. doi:10.
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