Recombinant Zoster Vaccine Reduces All-Cause Mortality, But Not Major Adverse Cardiovascular Events, in Patients With Immune-Mediated Inflammatory Diseases Receiving Janus Kinase Inhibitors

This study aims to assess the impact of recombinant zoster vaccine (RZV) on the risk of major cardiovascular events (MACE) in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA), or psoriatic diseases who are receiving Janus kinase inhibitors (JAKi). We conducted a new user design study utilizing the TriNetX database. We identified patients diagnosed with RA, SpA, or psoriatic diseases receiving JAKi. Two cohorts were constructed based on RZV vaccination status. Propensity score matching was performed. The primary outcome was MACE, analyzed using Cox regression with hazard ratios (HR) and Kaplan−Meier plots. Subgroup analyses were performed by age, sex, race, and zoster history. Sensitivity analyses were conducted with different follow-up periods and diseases. Of the 1 528 771 eligible patients initially included, each cohort included 1756 patients after propensity score matching. No significant difference in MACE risk was observed between the two cohorts (HR 1.121, 95% CI: 0.901−1.395). Subgroup and sensitivity analyses were consistent with the main findings. However, RZV vaccination was associated with a significant reduction in all-cause mortality (HR 0.610, 95% CI: 0.427−0.870). Subgroup analyses indicated that the mortality benefit was particularly evident in females (HR 0.585, 95% CI: 0.379−0.901) and those aged 65 years and older (HR 0.500, 95% CI: 0.301−0.806). In patients with immune-mediated inflammatory diseases receiving JAKi, RZV vaccination is associated with a 39% reduction in all-cause mortality compared to unvaccinated individuals. RZV vaccination should be considered for this high-risk population.