A type 1 non-ST-segment elevation myocardial infarction (NSTEMI) is a rare complication of shingles infection, especially in young individuals with few predisposing risk factors. A 39-year-old man, who was successfully treated for herpes zoster meningitis and encephalitis 3 months before this hospitalization, presented to the emergency department with worsening chest pain that radiated to his back with associated shortness of breath. Based on elevated troponin and abnormalities seen on electrocardiogram and transthoracic echocardiogram, the patient was diagnosed with a type 1 NSTEMI. A left heart catheterization was performed, resulting in a drug-eluting stent to the left anterior descending ostium. He was discharged with oral aspirin 81 mg daily, oral ticagrelor 90 mg twice daily, and oral rosuvastatin 20 mg daily. Infection with herpes zoster virus (HZV) has been temporally associated with increased risk of cardiovascular disease, even in those who are young with few predisposing risk factors. It has been postulated that HZV infection causes inflammation, subsequent hypercoagulability, vessel ischaemia, and arterial remodelling. More research needs to be conducted to further understand the possible mechanisms of action of HZV infection's effect on the heart.
Older adults living in post-acute and long-term care (PALTC) settings are especially vulnerable to vaccine-preventable illnesses, yet national data show that many are not up to date on recommended immunizations. This quality improvement (QI) project aimed to increase immunization coverage among PALTC residents while exploring improvement strategies tailored to this setting. QI project conducted in 2, 12-month cohorts between 2022 and 2024. QI teams from 15 skilled nursing facilities and 6 assisted living facilities across 9 states participated in the QI project. QI teams included staff and administrators working at the facility and corporate levels in roles such as medical directors, directors/assistant directors of nursing, and infection preventionists. QI teams implemented immunization strategies, reported monthly resident immunization coverage for 5 vaccines (COVID-19, influenza, pneumococcal, Tdap, and shingles), received monthly technical assistance, and met quarterly with other facilities to share lessons learned. We report resident immunization coverage at baseline and end point by facility and vaccine. To provide context, we share lessons learned and examples across facilities, including common improvement strategies. Seventeen facilities improved resident immunization coverage for at least 1 vaccine; 5 improved coverage for 4 or more. Common challenges included difficulty gathering and aggregating immunization data, limited staff bandwidth and high turnover, and vaccine resistance. Improvement efforts focused on monitoring immunization coverage, making immunization routine, and building organizational support for immunization. Learning from this large QI project shows that while there are many barriers to immunizing PALTC residents, both skilled nursing facilities and assisted living facilities can make meaningful improvements in resident immunization within a year with focused QI efforts and practical support. Investments in technology to automate immunization monitoring, strengthening pharmacy partnerships, and demonstrating leadership commitment to immunization are promising strategies for improving resident immunization in PALTC settings.
Herpes zoster (shingles) is a painful viral infection caused by the reactivation of varicella-zoster virus, often leading to prolonged recovery and postherpetic neuralgia. Although antiviral treatments are standard, adjunctive strategies such as personalized nutrition may modulate immune and inflammatory responses, potentially improving outcomes. This retrospective study evaluated the effects of personalized dietary interventions on serum inflammatory and immune markers, recovery time, pain, and quality of life in patients with herpes zoster. Notably, the two treatment arms had unequal sample sizes due to non-randomized assignment in routine clinical practice and adherence-based exclusions; the imbalance was analytically addressed using statistical tests robust to unequal group sizes, and baseline characteristics were comparable between groups. This retrospective study evaluated 258 herpes zoster patients at our hospital from April 2019 to April 2023, divided into Standard Diet (n = 136) and Personalized Diet (n = 122) groups. Personalized interventions were based on biological markers, medical history, and lifestyle factors. Key outcomes included changes in serum inflammatory markers (IL-6, IL-17, TNF-α, CRP, IgM, IgA), recovery time metrics, pain levels (VAS score), and quality of life (SF-36). The Personalized Diet Group demonstrated significantly greater reductions in serum IL-6, IL-17, TNF-α, and CRP levels compared to the Standard Diet Group (P < 0.05). Recovery times for vesicle cessation, pain relief, crusting, and overall healing were significantly shorter in the personalized group (P < 0.05). Additionally, personalized dietary interventions were associated with greater improvements in VAS pain scores and quality of life measures, particularly in mental health, social functioning, and role-emotional scores. Anxiety and depression scores (SAS and SDS) improved more significantly in the personalized group (P < 0.05). Personalized nutritional dietary recommendations signifcicantly improve inflammatory and immune responses, accelerate recovery, and enhance quality of life in herpes zoster patients.
To evaluate the effectiveness of an active recruitment strategy for vaccinating patients with solid-organ cancer through the scheduled surgery unit of a regional hospital. A descriptive study of patients identified between February 13, 2023, and December 20, 2024, using daily records of scheduled oncologic surgery. The Department of Preventive Medicine and Public Health sent an informational letter, an educational brochure, and an appointment notice to the Vaccination Unit. A total of 143 patients were identified; 18 were excluded, and 125 were included in the analysis. One hundred twenty (96.0%) attended the first appointment, and 116 (96.7% of attendees) began the vaccination series. Vaccination coverage rates were 96.64% for pneumococcal, 94.96% for shingles, and 78.15% for influenza and COVID-19. Early outreach integrated into the surgical process was feasible and achieved high vaccination coverage in a particularly vulnerable population.
Objective: To analyze the current status and changing trends of herpes zoster vaccination in Shandong Province from 2020 to 2024 and provide a reference for the prevention and control of herpes zoster in the population. Methods: The first dose of herpes zoster vaccine was collected from the Immunization Information System of Shandong Province from 2020 to 2024, and vaccination coverage was calculated based on population data. The temporal trend in vaccination coverage was analyzed using Joinpoint 5.3.0. Results: The vaccination coverage of the herpes zoster vaccine in Shandong Province showed an upward trend from 2021 to 2024 [average annual percentage change (AAPC)=46.48%, P=0.065], with the highest in 2023 (0.084%). The vaccination coverage of females was higher than that of males, but the growth rate of male vaccination coverage (AAPC=48.95%, P=0.057) was slightly higher than that of females (AAPC=45.11%, P=0.074). The vaccination coverage in regions with high gross domestic product (GDP) had a turning point in 2022, with rapid growth in 2021-2022 [annual percentage change (APC)=70.75%, P=0.028], and a flat growth rate in 2022-2024 (APC=4.91%, P=0.737), with the highest vaccination coverage in 2023 (0.094%). The growth rate of vaccination coverage in regions with medium GDP (AAPC=62.48%, P=0.039) and low GDP (AAPC=64.40%, P=0.040) was faster than that in regions with high GDP (AAPC=23.41%, P=0.037). The vaccination coverage was highest in the 50-59 age group, with the turning point in 2022. From 2021 to 2022, it increased rapidly (APC=128.03%, P=0.028), and from 2022 to 2024 (APC=5.68%, P=0.743), the growth rate tended to be flat. The growth trend in vaccination coverage in the 70-79 age group (AAPC=54.17%, P=0.024) and the 80- age group (AAPC=59.15%, P=0.028) was relatively fast. Conclusions: Herpes zoster vaccination coverage showed an upward trend in Shandong Province from 2020 to 2024, and vaccination coverage among the middle-aged population aged 50 to 69 has increased significantly. However, it is important to focus on increasing vaccination coverage in economically underdeveloped areas, among males, and older age groups. 目的： 分析2020-2024年山东省带状疱疹疫苗的接种现状和变化趋势，为带状疱疹的人群防控提供参考。 方法： 利用山东省预防接种信息系统中采集的2020-2024年带状疱疹疫苗首剂次接种数，结合人口数据计算疫苗接种率，并应用Joinpoint 5.3.0软件分析接种率的时间变化趋势。 结果： 2021-2024年山东省带状疱疹疫苗的接种率呈上升趋势［平均年变化百分比（AAPC）=46.48%，P=0.065］，2023年时最高（0.084%）。女性接种率高于男性，但男性接种率（AAPC=48.95%，P=0.057）的增速略高于女性（AAPC=45.11%，P=0.074）。高国内生产总值（GDP）地区接种率以2022年为转折点，2021-2022年快速增长［年变化百分比（APC）=70.75%，P=0.028］，2022-2024年增速平缓（APC=4.91%，P=0.737），2023年时接种率最高（0.094%）；中GDP地区（AAPC=62.48%，P=0.039）、低GDP地区（AAPC=64.40%，P=0.040）接种率增速快于高GDP地区（AAPC=23.41%，P=0.037）。50~59岁组的接种率最高，以2022年为转折点，2021-2022年上升较快（APC=128.03%，P=0.028），2022-2024年（APC=5.68%，P=0.743）增速趋于平缓；70~79岁组（AAPC=54.17%，P=0.024）、80~岁组（AAPC=59.15%，P=0.028）接种率的增速相对较快。 结论： 2020-2024年山东省带状疱疹疫苗接种率呈上升趋势，50~69岁人群接种率增速明显，需重点关注提高经济落后地区、男性和高年龄组人群的接种率。.
This study aimed to investigate the value of laser speckle contrast imaging in detecting facial blood perfusion in patients with peripheral facial palsy (PFP); to establish the evaluation criteria for facial blood perfusion; and to clarify the relationship between facial microcirculatory status, facial nerve function, and facial blood flow changes in PFP patients. Thirty healthy controls and 132 PFP patients receiving treatment at our hospital were chosen for laser speckle contrast imaging, in order to quantify their facial blood perfusion at the following 4 sites: the periocular region, the middle cheeks, the corners of the mouth, and the nasolabial fold. Blood perfusion values (BP) were measured for these sites, and the rate of blood flow changes was calculated as follows: R = (BPaffected side-BP healthy side)/BPhealthy side. The changes in blood flow rates in the periocular region and cheeks were significantly different between patients with severe peripheral facial paralysis (PFP) and healthy controls. However, no significant differences were observed at these sites between patients with Ramsay Hunt syndrome and those with Bell's palsy. In patients with moderate and severe PFP, the rate of blood flow changes in the periocular region was lower compared to healthy controls. Additionally, patients with severe PFP showed lower rates than those with moderate PFP. A lower Sunnybrook score in PFP patients correlated with a smaller rate of blood flow changes in the periocular region. For patients with Bell's palsy, blood flow rate changes in the periocular region at two- and four-months post-surgery were significantly different from pre-surgery levels. There was also a significant difference between the rates at two and four months. In patients with Ramsay Hunt syndrome, the rate of blood flow changes at two months post-surgery did not significantly differ from pre-surgery. No significant difference in blood flow rate changes at two months post-surgery was observed between patients with Bell's palsy and Ramsay Hunt syndrome. Facial blood perfusion decreased with the severity of facial nerve injury in PFP patients, regardless of the etiology. Postoperative improvements were significant in Bell's palsy, but slower in Ramsay Hunt syndrome.
Herpes zoster pseudoabdominal hernia (HZV-PAH) is a rare and easily misdiagnosed complication after varicella-zoster virus (VZV) infection, which is essentially a neurogenic muscle dysfunction rather than a true hernia. HZV-PAH refers to the dysfunction of nerves innervating abdominal wall muscles (especially the transversus abdominis and internal oblique muscles) caused by VZV invasion of intercostal or lumbar nerves, leading to local muscle relaxation, paralysis, or bulging, resulting in local bulging of the abdominal wall. This disease is relatively rare, with fewer than 2% of cases of abdominal pseudo-hernia reported after herpes zoster infection, mostly occurring in elderly patients with herpes zoster, those with impaired immunity, or those with extensive involvement of dermatomes. HZV-PAH is a neurogenic muscle disease without anatomical defects of the abdominal wall. Clinicians should improve their awareness of early identification and differential diagnosis to avoid misdiagnosis and unnecessary surgical treatment.
Immunization is very important in public health because it reduces the spread of infectious diseases. It has been an essential part of health care programs as it prevents and controls a wide range of vaccine-preventable diseases worldwide. The main objective of this Clinical Practice Guidelines (CPG) is to provide evidence-based recommendations on immunization for the prevention of vaccine-preventable diseases among apparently healthy adults and those with high-risk conditions. We followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to CPG development recommended in the Department of Health Manual, including GRADE Adolopment and the GRADE Evidence-to-Decision or EtD frame-work. This CPG contains the systematic synthesis of scientific evidence on immunization for Cholera, Haemophilus influenzae type b (Hib), Hepatitis A, Herpes Zoster, Human Papillomavirus (HPV), Influenza, Japanese Encephalitis, Measles, Meningococcal, Mpox, Pneumococcal, Rabies, Tetanus, Typhoid, and Varicella in the adult population. The CPG provides forty-one (41) recommendations on prioritized questions regarding fifteen (15) vaccines. The systematic review of evidence was used to assess each vaccine's efficacy, safety, and costeffectiveness. These recommendations can be used by relevant stakeholders, particularly in the public health units, those in primary care practice and the administrative sectors involved in implementing vaccination programs.
To evaluate infection risks in rheumatoid arthritis (RA) patients with biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs) as monotherapy or combined with conventional synthetic DMARDs (csDMARDs). A comprehensive literature search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov from their inception to 31 October 2024 was conducted to identify randomized controlled trials (RCTs) assessing infection risks in RA patients receiving b/tsDMARDs. Primary outcome was serious infection incidence; secondary outcomes included any infection and specific events such as respiratory tract infections, gastroenteritis and herpes zoster. A frequentist network meta-analysis was performed to calculate odds ratios (ORs). A total of 127 RCTs involving 55,749 patients were included. b/tsDMARD monotherapy showed a similar risk of serious infections versus csDMARDs. Combining csDMARDs with adalimumab, infliximab, tofacitinib, or upadacitinib (though not with other b/tsDMARDs) was associated with a significantly increased risk of serious infections (OR 1.51, 95% CI: 1.04-2.19; OR 1.75, 95% CI: 1.09-2.81; OR 2.52, 95% CI: 1.26-5.03; OR 2.31, 95% CI: 1.13-4.73). For any infection, b/tsDMARD monotherapy posed a similar risk to csDMARDs, except for etanercept. Certain tsDMARDs were associated with an increased incidence of herpes zoster versus csDMARDs, except for filgotinib and peficitinib. Compared to csDMARDs, b/tsDMARD monotherapy showed no elevated serious infection risk, whereas specific combinations increased the risk of serious infections in RA patients. A clinical reference pathway was developed to inform drug selection optimization for RA patients receiving b/tsDMARDs.
Valacyclovir requires dose adjustment according to renal function to prevent serious adverse events. However, real-world data on renal function-based dosing practices are limited. To evaluate the frequency of valacyclovir overdosing according to renal function and to identify the characteristics associated with overdosing in Japan. We conducted a retrospective cohort study using a nationwide database of administrative claims and laboratory results from acute care hospitals in Japan. We included adults aged ≥18 years who received at least 1 valacyclovir prescription between October 1, 2022, and September 30, 2024, and who had a serum creatinine measurement within the preceding year. The primary outcome was overdosing, defined as a prescribed dose that exceeded the maximum recommended dose for the patient's renal function level per the Japanese package insert. Renal function was estimated using creatinine clearance calculated with the Cockcroft-Gault equation. A total of 6764 patients with 7901 valacyclovir prescriptions were included; 1649 prescriptions (20.9%) were for patients with impaired renal function. Overdosing was rare among patients with normal renal function. Among patients with impaired renal function, overdosing occurred in 25.1% of prescriptions for varicella or herpes zoster and in 6.4% for other indications. Overdosing was more frequent among women and most common for prescriptions dispensed at community pharmacies. In this nationwide study, valacyclovir overdosing was common among patients with impaired renal function, particularly for high-dose indications, and occurred more frequently among women and for prescriptions dispensed at community pharmacies. Strengthening renal function-based prescription review may help reduce preventable overdosing.
In 2020, an estimated 14.9 million herpes zoster (HZ) cases occurred worldwide among adults aged ≥ 50 years; this number is projected to rise to 19.1 million by 2030. Postherpetic neuralgia (PHN), the most common complication of HZ, develops in 5% to > 30% of patients with HZ. Poorly managed PHN may cause persistent pain, functional impairment, psychological distress, and, in severe cases, suicide. This review summarizes the current evidence on PHN and proposes a tiered management framework. PubMed and Web of Science were searched for PHN-related articles published from January 2011 to December 2025, with reference-list screening. Studies were selected by clinical relevance and design. Management strategies were tiered by guideline support, regulatory approval, and PHN-specific efficacy and safety evidence. Pathogenesis involves viral reactivation, peripheral and central sensitization, and genetic modulation. Major risk factors include older age, severe acute pain, extensive rash, craniofacial/thoracic involvement, immunocompromise, comorbidities, and treatment delay. Management of PHN is tiered: Tier 1 treatments include gabapentinoids, the 5% lidocaine patch, tricyclic antidepressants, duloxetine, and the 8% capsaicin patch; Tier 2 treatments include botulinum toxin type A injections, pulsed radiofrequency, and temporary spinal cord stimulation (tSCS); and Tier 3 options include opioids and neuromodulation. PHN remains the most common and therapeutically challenging complication of HZ. Although a stratified framework for PHN management has been proposed, it still requires validation in clinical practice and further refinement to support more effective individualized treatment.
This study describes the effect of nasal neurostimulation in five cases of postherpetic neuralgia (PHN) after herpes zoster ophthalmicus. This retrospective case series included five symptomatic patients with PHN who were receiving conventional pain therapy and underwent a single session of nasal neurostimulation for additional oculofacial pain relief. Neurostimulation was performed either through intranasal or extranasal application. Pain intensity was assessed before and after treatment using the visual analog scale (VAS; 0-10). Three patients received intranasal and two received extranasal neurostimulation therapy. Despite maximum tolerated systemic and ocular pain treatments, mean baseline oculofacial pain VAS scores ranged between 3 and 4 of 10 in the intranasal group and 2 and 3 of 10 in the extranasal group. All patients reported complete pain relief following neurostimulation. The duration of pain relief ranged from four to eight hours after a single treatment session. Nasal neurostimulation may represent a promising adjuvant therapy for patients with PHN who are receiving conventional pain treatment and are seeking additional oculofacial pain relief.
Patients undergoing lung transplantation (LTx) are at risk of clinical deterioration during hospital ward care. The epidemiology of Medical Emergency Team (MET) calls in LTx patients and their association with patient outcomes are poorly described. We aimed to (1) measure the frequency, timing, and characteristics of MET activations in patients undergoing LTx, (2) evaluate differences in demographics and outcomes between those who had a MET call vs those who didn't. A retrospective cohort study of patients who received MET calls during their index admission for LTx at the Alfred Hospital between January 2016 and December 2021. Amongst 535 patients undergoing LTx, MET activation occurred in 265 (49.5%), with 738 MET activations in total. The MET group had a median (IQR) of 2 (1-4) MET calls. Pre-LTx period accounted for 15% of the calls, with hypoxia being the most common trigger (49.5%). During the post-LTx period, tachycardia (28.5%) and hypotension (33.1%) were the most common triggers. Hospital length-of stay (LOS) was longer in the MET group (26 [19-41] vs 19 days [15-27], p < 0.001), and ICU readmission occurred more frequently (27.5 vs 2.2%, p < 0.001). Post LTx MET activation had no impact on 90-day mortality [Adj HR (95% CI): 1.41 (0.19-10.60); p = 0.74] or on long-term survival [Adj HR (95% CI): 1.09 (0.80-1.49); p = 0.59]. MET activation is common in patients undergoing LTx. Admissions with MET are associated with higher rates of ICU readmission and longer hospital LOS compared to the no MET group, without affecting survival outcomes.
Herpes simplex virus type 1 (HSV-1) and varicella zoster virus (VZV) are neurotropic human alphaherpesviruses that establish lifelong latency in peripheral ganglia. While traditionally studied in isolation, increasing evidence indicates that co-reactivation of these viruses may be clinically significant, especially in the context of aging and immunosuppression, and underdiagnosed. Recent studies show that both viruses can reside in the same trigeminal ganglion (TG) and interact synergistically to potentiate and exacerbate neurological and neurodegenerative disease. This review summarizes emerging insights into the clinical, immunological, and neuropathological implications of HSV-1 and VZV co-reactivation, with a particular emphasis on VZV-derived extracellular vesicles (EVs) as mediators of immune suppression and enhancers of secondary HSV-1 infection.
Herpes zoster (HZ), caused by varicella zoster virus reactivation, is uncommon in immunocompetent children without prior varicella exposure. We describe a 22-month-old boy who developed HZ 4 months after varicella vaccination, presenting with a unilateral dermatomal vesicular rash. Serological testing was positive for IgM. No maternal or postnatal varicella exposure was reported, and the child had no immunodeficiency. This case underscores the rare possibility of HZ in vaccinated young children lacking traditional risk factors, highlighting the need for clinical vigilance even in atypical populations. Further investigation into triggers of early VZV reactivation postvaccination is warranted.
Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides are systemic autoimmune disorders affecting small- and medium-sized vessels. Cutaneous involvement is common, but diagnosis can be challenging when inflammatory lesions mimic infectious processes, particularly fungal infections such as cryptococcosis. We describe two female patients with ANCA-associated vasculitis who developed widespread cutaneous lesions with histopathological features resembling Cryptococcus. The first patient, a 57-year-old woman with p-ANCA MPO-positive vasculitis, presented with bullous and purpuric lesions along with pulmonary hemorrhage. Despite corticosteroids and cyclophosphamide, her disease course was complicated by multiorgan involvement and fatal outcome. The second patient, a 73-year-old woman with multiple comorbidities, developed vesicular and necrotic skin lesions initially misdiagnosed as disseminated herpes zoster. Histology demonstrated vasculitis with Cryptococcus-like changes, and after exclusion of fungal infection, immunosuppressive therapy led to complete resolution. Cryptococcus-like histopathological changes have been reported in neutrophilic dermatoses, described as cryptococcoid Sweet syndrome. These yeast-like structures are thought to represent degenerating neutrophils rather than fungal organisms. Awareness of this rare finding is essential to avoid unnecessary antifungal therapy and ensure prompt initiation of immunosuppression. Cutaneous Cryptococcus-like changes in ANCA vasculitis are rare but clinically significant. Accurate diagnosis requires integration of clinical context, microbiological testing, and histopathology. Early recognition is critical to guide appropriate management and improve patient outcomes.
Propofol is widely used in clinical anesthesia, but its cardiorespiratory depressive effects may limit its safety in older patients. With the growing number of older adults requiring anesthesia, ciprofol has attracted interest because of its higher potency and relatively mild hemodynamic impact. This meta-analysis evaluated the efficacy and safety of ciprofol compared with propofol in older patients undergoing general anesthesia or painless endoscopy. We conducted a comprehensive search of PubMed, Embase, the Cochrane Library, and Web of Science up to 7 November, 2025, to identify eligible studies. All statistical analyses were performed using RevMan 5.4 and R version 4.5.1. A total of 12 randomized controlled trials involving 2027 older participants were included. For safety outcomes, ciprofol significantly reduced the incidence of hypotension (risk ratio = 0.76, 95% confidence interval 0.68-0.84; p < 0.00001) and injection pain (risk ratio = 0.16, 95% confidence interval 0.09-0.26; p < 0.00001) compared with propofol. No significant differences were observed between the two agents in the incidence of bradycardia, hypoxemia, and postoperative nausea and vomiting. Regarding efficacy outcomes, ciprofol was associated with a longer time to loss of consciousness compared with propofol (mean difference = 4.67 seconds, 95% confidence interval 0.65-8.70; p = 0.02), while no significant differences were observed in anesthesia success rate, procedure completion rate, and awakening time. Based on the currently available evidence from randomized trials conducted in China, ciprofol showed comparable efficacy to propofol and was associated with lower incidences of hypotension and injection pain in older patients. These findings may still be informative for anesthetic management in broader settings, although further validation is needed. PROSPERO registration number: CRD420251179366.
Herpes zoster (HZ), caused by reactivation of the varicella-zoster virus, is often linked to immunosuppression and can present atypically. This case series describes nine patients: five human immunodeficiency virus (HIV)-positive adults with reduced CD4 counts (380-458 cells/mm3) and two children on immunosuppressive therapy for leukemia. Adult cases showed severe pain and lesions across multiple dermatomes, with facial or thoracic involvement. Two had high-risk sexual behavior, and one had recurrent episodes. The children presented with severe pain and vesicular lesions; one had noncontiguous dermatomal involvement. The findings underscore the role of immunosuppression, particularly HIV and leukemia therapy, in atypical HZ presentations.
Anifrolumab, a type I interferon receptor antagonist, has shown effectiveness in treating moderate-to-severe systemic lupus erythematosus (SLE). To fully understand its long-term efficacy, glucocorticoid (GC)-sparing potential, and cumulative safety profile in everyday clinical practice, it is essential to combine up to 4 years of long-term extension (LTE) trial data with emerging real-world evidence (RWE). A systematic literature search was performed across major electronic databases to identify phase 2/3 randomized controlled trials (RCTs), long-term extension (LTE) studies, and RWE cohorts assessing anifrolumab in SLE. Comparative odds ratios (ORs) for RCTs were calculated using the Mantel-Haenszel method, while pooled proportions for single-arm RWE cohorts were estimated using a random-effects model. Primary outcomes included BICLA response, Lupus Low Disease Activity State (LLDAS), GC reduction (to ≤ 7.5 mg/day), and Herpes Zoster (HZ) incidence. Ten studies were included, comprising phase 2/3 RCTs, their LTEs (TULIP-LTE, MUSE-LTE), and four European RWE cohorts. In the RCTs (N = 1,093), anifrolumab significantly improved BICLA responses compared to placebo (pooled OR 1.85, 95% CI 1.42-2.41, p < 0.001) and enhanced the likelihood of achieving a target GC dose of ≤ 7.5 mg/day (OR 2.24, 95% CI 1.52-3.29, p < 0.001). In the pooled RWE cohorts (N = 294), the estimated attainment rate for LLDAS at 6-12 months was notably high at 75.8% (95% CI 68.4-82.5%). Additionally, 72.5% of real-world patients achieved a >50% reduction in GC dosage. Regarding safety, there was no significant increase in overall serious adverse events (SAEs) (OR 0.82, p = 0.25). Although anifrolumab was linked to a higher risk of HZ (OR 3.45, 95% CI 1.95-6.10, p < 0.001), both LTE and RWE data indicated that these cases were mainly mild to moderate and manageable. Anifrolumab offers rapid, strong, and sustained disease control while providing significant GC-sparing effects in both tightly controlled clinical trials and diverse real-world populations. The long-term safety profile remains stable; however, preventative measures, such as HZ vaccination, should be implemented as part of standard care.
Patients with myeloproliferative neoplasms (MPN) are at increased risk of herpes zoster, particularly during Janus kinase inhibitor (JAKi) therapy, yet the immunogenicity of recombinant zoster vaccine (RZV) in this setting remains incompletely characterized. We performed a prospective pilot translational study including 18 patients with MPN and a small age-matched healthy donor group (n = 4, descriptive reference only). Samples were collected at baseline, 21 days after the first dose, and 21 days after the second dose. Humoral response was assessed by anti-varicella-zoster virus (VZV) immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA), whereas antigen-specific cellular responses were evaluated after ex vivo stimulation with recombinant VZV glycoprotein E followed by flow cytometry and cytokine quantification. IgG levels increased over time in MPN patients, while cellular responses remained limited, heterogeneous, and not consistently enhanced. Cytokine production was low and variable across time points. Overall, RZV in MPN under JAKi was associated with detectable humoral responses but limited cellular activation, supporting an apparent discordance between humoral and cellular immune readouts under the experimental conditions used.