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14-08-2019 | Gout | News

Vaccination may increase gout flare risk

medwireNews: The increased risk for gout flares following receipt of the aluminum-free recombinant zoster vaccine (RZV) is not unique to this vaccine but is instead associated with vaccination in general, regardless of the adjuvant used, US researchers report.

However, Hyon Choi (Massachusetts General Hospital, Boston) and colleagues stress that “the absolute magnitude of increased odds of gout flares with vaccinations remains small.”

The researchers explain that although RZV is “the preferred zoster vaccine endorsed by the Advisory Committee on Immunization Practices,” two phase III clinical trials have shown that it is associated with a 3.6-fold increased risk for gout flares, prompting the implementation of an enhanced postmarketing surveillance program.

However, the findings of the current study, conducted between 2003 and 2010 prior to the introduction of the RZV vaccine, “suggest that this adverse effect is also applicable to other vaccines, although the effect size may be lower,” Choi and co-authors write in the Annals of the Rheumatic Diseases.

The researchers used a web-based platform to collect information on risk factor exposure at the time of a gout flare. The 517 participants (mean age 55 years, 79% male) were asked to log in to the website during a flare and give details about purine intake, alcohol consumption, and medication exposures, including whether they had received any vaccinations during the 2-days preceding the flare (ie, the hazard period).

The participants were also asked the same questions over a 2-day period when the they were free from a gout flare (ie, the control period) every 3 months during the 1-year follow-up period.

During this time, there were 990 hazard periods that included 28 reported vaccinations and 1407 control periods with 21 vaccinations.

After adjustment for purine intake, alcohol consumption, and diuretic use, the researchers found that vaccination was associated with a significant 1.99-fold increased likelihood of experiencing a gout flare, relative to no vaccination.

They say this indicated that “vaccines other than RZV are associated with increased odds of gout flares, potentially through a shared pathogenetic mechanism like NLRP3 inflammasome” as both the non-aluminum adjuvant contained in RZV and aluminum adjuvants, which are found in around half of all routine adult vaccines, have been associated with activation of this inflammatory protein complex.

Choi et al also emphasize that their findings “must be interpreted within the context of overwhelming benefits of vaccines worldwide.”

Indeed, they add: “Given the high prevalence of gout among patients most susceptible to adverse outcomes from infections, such as the elderly and those with multiple comorbidities, avoiding vaccinations due to the increased odds of gout flares is not advisable.”

By Laura Cowen

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

Ann Rheum Dis 2019; doi:10.1136/ annrheumdis-2019-215724

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