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Risk for herpes zoster is elevated in patients with rheumatoid arthritis (RA), and treatment with some biologic agents (e.g., tofacitinib [Xeljanz]) further increases this risk. However, the current zoster vaccine contains live attenuated virus and is relatively contraindicated in patients who are receiving tofacitinib or other biologics. In this phase II trial, funded by the maker of tofacitinib, 112 RA patients (age, ≥50) who were on background therapy with methotrexate were administered live-attenuated zoster vaccine; participants then were randomized to receive tofacitinib (5 mg twice daily) or placebo starting at 2 to 3 weeks after vaccination.
At 6 weeks postvaccination, rises in varicella-zoster virus (VZV)–specific IgG levels (a prim…