Safety of Zostavax Vaccination in Rheumatoid Arthritis

Rheumatoid Arthritis Clinical Trial

Official title:

Immune Response to Varicella Zoster Vaccination (ZOSTAVAX) in Subjects With Rheumatoid Arthritis

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01506661
• Other study ID #: OMRF11-53
• Status: Completed
• Phase: Phase 1
• Start date: January 2012
• Est. completion date: October 2018

Study information

• Verified date: March 2020
• Source: Oklahoma Medical Research Foundation
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Herpes Zoster (shingles) is caused by reactivation of latent varicella zoster virus (VZV) that usually occurs decades following initial exposure. The risk of developing shingles increases with age. Shingles presents as a painful, itchy blistering rash that usually involves a single portion of the skin and lasts about 7-10 days. The risk of developing shingles increases with age in healthy people, and has been shown in some studies to be increased in people with rheumatoid arthritis and other autoimmune diseases.

Zostavax, a live-attenuated vaccine against the varicella zoster virus, was first approved by the FDA for the prevention of Shingles among people 60 years and older, and is now approved for use in people aged 50 years and older. Because rheumatoid arthritis and some of the medications used to treat rheumatoid arthritis can impair the body's immune system, it is not known how much of an immune response can be generated in people with rheumatoid arthritis.

The goals of this study are to measure the immune response after standard vaccination with Zostavax in people with rheumatoid arthritis in comparison to people with healthy immune systems. All participants will be 50 years old or older, and subjects with rheumatoid arthritis will not be eligible if they are taking certain biologic medications, including TNF inhibitors (Etanercept or Adalimumab). Ten healthy subjects and 10 subjects with rheumatoid arthritis will all receive a single vaccination with Zostavax, then will be followed for 12 weeks to assess the immune response and for the development of local rash or other potential side effects.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 20
• Est. completion date: October 2018
• Est. primary completion date: December 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 50 Years to 80 Years

Eligibility

Inclusion Criteria:

• Age = 50 years

• Willing and able to provide written informed consent

• History of primary varicella vaccination or positive VZV IgG antibodies

• Diagnosis of RA according to ACR criteria for > 1 year, or healthy control subject

• Stable, mild disease activity as defined by a DAS28 score of 4.0

• Current medical treatment for RA has been stable for 4 weeks prior to screening

• Acceptable immunosuppressive medications are limited to Prednisone = 10 mg daily Methotrexate = 20 mg weekly Hydroxychloroquine = 6.5 mg/kg daily Any TNF inhibitor

• Female subjects of childbearing potential and non-sterile males must agree to use acceptable form of contraception for the duration of the study

Exclusion Criteria:

• History of receiving any VZV-containing vaccine

• History of herpes zoster reactivation (shingles) within 5 years of enrollment

• Received any vaccine within 6 weeks

• Known Hepatitis B, C or HIV virus infection

• History of drug or alcohol abuse within 1 year

• Rituximab therapy within 2 years of screening

• Cyclophosphamide within 6 months of screening

• Biologic therapy: TNF inhibitors with longer half-lives (infliximab, golimumab, etc), or other non-TNF biologic therapies (IL-1 or IL-6 inhibition, or CTLA-4Ig)

• Use of mycophenolate mofetil within 3 months of screening

• History of receiving immunoglobulin or other blood product within 3 months of screening

• Allergic reaction, intolerance or other contraindication to use of famciclovir.

• Has received an experimental/investigational agent (vaccine, drug, biologic, device, blood product, or medication) within 3 months of screening; or expects to receive another experimental/investigational agent within 6 months post immunization.

• Pregnant or lactating women

• Unwilling to use acceptable method of contraception for the duration of the study

• WBC <3.0; ANC <1500; CD4+ <200

• Proteinuria >1.5 mg/day

• Impaired renal function defined by serum Cr >1.5

• Transaminases > 2x upper limit of normal

• DAS28 > 4

• Anticipation of need to increase level of immunosuppression or add biologic therapy for 6 months following dosing.

• History of neoplastic disease within 5 years of screening, except for completely excised non-melanoma cancer of the skin or in-situ carcinoma of the uterine cervix.

• History of any hematological malignancy, current bleeding disorder or taking anticoagulant medication (heparin or warfarin).

• Any condition that would, in the opinion of the site investigator, place the subject at an unacceptable risk of injury or render the subject unable to meet the requirements of the protocol.

Related Conditions & MeSH terms

• Arthritis
• Arthritis, Rheumatoid
• Chickenpox
• Herpes Zoster
• Rheumatoid Arthritis
• Varicella Zoster
• Varicella Zoster Virus Infection

Intervention

Drug:
• Zostavax (varicella zoster virus) vaccine
Standard vaccination protocol for Zostavax will be utilized. 0.65 ml (19,400 plaque forming units) Zostavax will be administered subcutaneously once at the baseline visit

Locations

Country	Name	City	State
United States	Oklahoma Medical Research Foundation	Oklahoma City	Oklahoma

Sponsors (1)

Lead Sponsor	Collaborator
Oklahoma Medical Research Foundation

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Safety and development of localized herpes zoster lesions	The primary outcome of the study is assessment of adverse events, including injection site reactions and development of zoster-like lesions, following vaccination in subjects with RA compared to healthy subjects	12 weeks
Secondary	Immunogenicity	The secondary objective of the study is immunogenicity. Specifically, the change from baseline in varicella-zoster virus-specific cell mediated immunity (assessed by IFN-g ELISpot) between subjects with RA and healthy subjects will be compared.	6 weeks