PMID- 30361202
OWN - NLM
STAT- MEDLINE
DCOM- 20190225
LR  - 20190225
IS  - 1756-1833 (Electronic)
IS  - 0959-8138 (Linking)
VI  - 363
DP  - 2018 Oct 25
TI  - Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50
      and older: systematic review and network meta-analysis.
PG  - k4029
LID - 10.1136/bmj.k4029 [doi]
AB  - OBJECTIVE: To compare the efficacy, effectiveness, and safety of the herpes
      zoster live attenuated vaccine with the herpes zoster adjuvant recombinant
      subunit vaccine or placebo for adults aged 50 and older. DESIGN: Systematic
      review with bayesian meta-analysis and network meta-analysis. DATA SOURCES:
      Medline, Embase, and Cochrane Library (inception to January 2017), grey
      literature, and reference lists of included studies. ELIGIBILITY CRITERIA FOR
      STUDY SELECTION: Experimental, quasi-experimental, and observational studies that
      compared the live attenuated vaccine with the adjuvant recombinant subunit
      vaccine, placebo, or no vaccine in adults aged 50 and older. Relevant outcomes
      were incidence of herpes zoster (primary outcome), herpes zoster ophthalmicus,
      post-herpetic neuralgia, quality of life, adverse events, and death. RESULTS: 27 
      studies (22 randomised controlled trials) including 2 044 504 patients, along
      with 18 companion reports, were included after screening 2037 titles and
      abstracts, followed by 175 full text articles. Network meta-analysis of five
      randomised controlled trials found no statistically significant differences
      between the live attenuated vaccine and placebo for incidence of laboratory
      confirmed herpes zoster. The adjuvant recombinant subunit vaccine, however, was
      statistically superior to both the live attenuated vaccine (vaccine efficacy 85%,
      95% credible interval 31% to 98%) and placebo (94%, 79% to 98%). Network
      meta-analysis of 11 randomised controlled trials showed the adjuvant recombinant 
      subunit vaccine to be associated with statistically more adverse events at
      injection sites than the live attenuated vaccine (relative risk 1.79, 95%
      credible interval 1.05 to 2.34; risk difference 30%, 95% credible interval 2% to 
      51%) and placebo (5.63, 3.57 to 7.29 and 53%, 30% to 73%, respectively). Network 
      meta-analysis of nine randomised controlled trials showed the adjuvant
      recombinant subunit vaccine to be associated with statistically more systemic
      adverse events than placebo (2.28, 1.45 to 3.65 and 20%, 6% to 40%,
      respectively). CONCLUSIONS: Using the adjuvant recombinant subunit vaccine might 
      prevent more cases of herpes zoster than using the live attenuated vaccine, but
      the adjuvant recombinant subunit vaccine also carries a greater risk of adverse
      events at injection sites. PROTOCOL REGISTRATION: Prospero CRD42017056389.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Tricco, Andrea C
AU  - Tricco AC
AUID- ORCID: http://orcid.org/0000-0002-4114-8971
AD  - Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's
      Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada
      triccoa@smh.ca.
AD  - Epidemiology Division, Dalla Lana School of Public Health, University of Toronto,
      155 College Street, Toronto, M5T 3M7, ON, Canada.
FAU - Zarin, Wasifa
AU  - Zarin W
AD  - Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's
      Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
FAU - Cardoso, Roberta
AU  - Cardoso R
AD  - Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's
      Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
FAU - Veroniki, Areti-Angeliki
AU  - Veroniki AA
AD  - Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's
      Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
FAU - Khan, Paul A
AU  - Khan PA
AD  - Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's
      Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
FAU - Nincic, Vera
AU  - Nincic V
AD  - Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's
      Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
FAU - Ghassemi, Marco
AU  - Ghassemi M
AD  - Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's
      Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
FAU - Warren, Rachel
AU  - Warren R
AD  - Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's
      Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
FAU - Sharpe, Jane P
AU  - Sharpe JP
AD  - Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's
      Hospital, 209 Victoria Street, East Building, Toronto, M5B 1W8, ON, Canada.
FAU - Page, Andrea V
AU  - Page AV
AD  - Division of Infectious Diseases, Mount Sinai Hospital, Joseph and Wolf Lebovic
      Health Complex, Toronto, ON, Canada.
AD  - Department of Medicine, University of Toronto, Toronto, ON, Canada.
FAU - Straus, Sharon E
AU  - Straus SE
AD  - Department of Medicine, University of Toronto, Toronto, ON, Canada.
AD  - St Michael's Hospital, Toronto, ON, Canada.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20181025
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
RN  - 0 (Adjuvants, Immunologic)
RN  - 0 (Herpes Zoster Vaccine)
RN  - 0 (Vaccines, Attenuated)
SB  - AIM
SB  - IM
CIN - BMJ. 2018 Oct 25;363:k4203. PMID: 30361204
MH  - Adjuvants, Immunologic
MH  - Aged
MH  - Female
MH  - Health Services for the Aged
MH  - Herpes Zoster/*prevention & control
MH  - Herpes Zoster Vaccine/administration & dosage/adverse
      effects/chemistry/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Vaccines, Attenuated
PMC - PMC6201212
COIS- Competing interests: All authors have completed the ICMJE uniform disclosure form
      at www.icmje.org/coi_disclosure.pdf and declare that all authors had financial
      support from the Canadian Institutes of Health Research Drug Safety and
      Effectiveness Network (DNM-137713); authors have no financial relationships with 
      any organisations that might have an interest in the submitted work in the
      previous three years; and no other relationships or activities to declare that
      could appear to have influenced the submitted work.
EDAT- 2018/10/27 06:00
MHDA- 2019/02/26 06:00
CRDT- 2018/10/27 06:00
PHST- 2018/10/27 06:00 [entrez]
PHST- 2018/10/27 06:00 [pubmed]
PHST- 2019/02/26 06:00 [medline]
AID - 10.1136/bmj.k4029 [doi]
PST - epublish
SO  - BMJ. 2018 Oct 25;363:k4029. doi: 10.1136/bmj.k4029.