The comparative efficacy and safety of herpes zoster vaccines: A network meta-analysis

Ashleigh McGirr; Robyn Widenmaier; Desmond Curran; Emmanuelle Espié; Tomas Mrkvan; Lidia Oostvogels; Benedetto Simone; Janet E McElhaney; Heather Burnett; Katrin Haeussler; Adriana Thano; Xuan Wang; Rachel S Newson

doi:10.1016/j.vaccine.2019.04.014

The comparative efficacy and safety of herpes zoster vaccines: A network meta-analysis

Vaccine. 2019 May 16;37(22):2896-2909. doi: 10.1016/j.vaccine.2019.04.014. Epub 2019 Apr 11.

Authors

Affiliations

¹ GSK Canada, 7333 Mississauga Rd N, Mississauga, ON L5N 6L4, Canada. Electronic address: ashleigh.a.mcgirr@gsk.com.
² GSK Canada, 7333 Mississauga Rd N, Mississauga, ON L5N 6L4, Canada.
³ GSK, 20 Avenue Fleming, Wavre 1300, Belgium.
⁴ GSK, Stockley Park West, 1-3 Ironbridge Road, Uxbridge, Middlesex UB11 1BT, United Kingdom.
⁵ Health Sciences North Research Institute, 41 Ramsey Lake Road, Sudbury P3E 5J1, Canada.
⁶ Evidera, 7575 Trans-Canada Hwy, Suite 404, St-Laurent, Quebec H4T 1V6, Canada.
⁷ ICON plc, Konrad-Zuse-Platz 11, 81829 München, Germany.
⁸ ICON plc, De Molen 84, Houten 3995 AX, the Netherlands.
⁹ ICON plc, Klarabergsviadukten 90 Hus D, Stockholm 111 64, Sweden.

PMID: 30982636
DOI: 10.1016/j.vaccine.2019.04.014

Abstract

Background: We estimated the relative efficacy and safety of vaccines for prevention of herpes zoster (HZ) using network meta-analysis (NMA) based on evidence from randomized controlled trials.

Methods: A systematic literature review evaluated two different HZ vaccines: adjuvanted recombinant zoster vaccine (RZV) and zoster vaccine live (ZVL), with different formulations assessed. Detailed feasibility assessment indicated that a NMA was feasible for efficacy (incidence of HZ and postherpetic neuralgia [PHN]) and safety (serious adverse events [SAE] and reactogenicity [injection-site reactions, systemic reaction]) outcomes. Primary analyses included frequentist NMAs with fixed effects for efficacy outcomes, due to limited data availability, and both fixed and random effects for safety and reactogenicity outcomes. As age is a known effect modifier of vaccine efficacy (VE), VE analyses were stratified by age.

Results: RZV demonstrated significantly higher HZ efficacy than ZVL in adults ≥60 years of age (YOA) (VE_RZV = 0.92 (95% confidence interval [95%CI]: 0.88, 0.94), VE_ZVL = 0.51 (95%CI: 0.44, 0.57)) and adults ≥70 YOA (VE_RZV = 0.91 (95%CI: 0.87, 0.94), VE_ZVL = 0.37 (95%CI: 0.25, 0.48)). Similarly, RZV demonstrated significantly higher PHN efficacy than ZVL in adults ≥60 YOA (VE_RZV = 0.89 (95%CI: 0.70, 0.96), VE_ZVL = 0.66 (95%CI: 0.48, 0.78)) and adults ≥70 YOA (VE_RZV = 0.89 (95%CI: 0.69, 0.96), VE_ZVL = 0.67 (95%CI: 0.44, 0.80)). RZV was associated with significantly more injection-site and systemic reactions compared to most formulations of ZVL and placebo, however definitions and data collection procedures differed across the included studies. There were no statistically significant differences found between RZV and any formulation of ZVL or placebo for SAEs.

Conclusion: RZV is significantly more effective in reducing HZ and PHN incidence in adults ≥60 YOA, compared with ZVL. As anticipated with an adjuvanted vaccine, RZV results in more reactogenicity following immunization. No differences in SAEs were found between RZV and ZVL.

Keywords: Comparative efficacy; Herpes zoster; Post-herpetic neuralgia; Reactogenicity; Safety; Vaccine.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Herpes Zoster / immunology
Herpes Zoster / prevention & control
Herpes Zoster Vaccine / adverse effects
Herpes Zoster Vaccine / therapeutic use*
Humans
Network Meta-Analysis
Neuralgia, Postherpetic / immunology
Neuralgia, Postherpetic / prevention & control

Substances

Herpes Zoster Vaccine