Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis
BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4029 (Published 25 October 2018) Cite this as: BMJ 2018;363:k4029Linked Editorial
Which shingles vaccine for older adults?
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The network meta-analysis from Tricco et al about the efficacy of adjuvant, recombinant subunit vaccine compared to placebo and live attenuated vaccine for prevention of herpes zoster, shows data which may be of great interest to public health. The network meta-analysis on the efficacy of adjuvant, recombinant subunit herpes zoster vaccine states the efficacy of adjuvant, recombinant subunit herpes zoster vaccine for confirmed cases of herpes zoster as 94% (95% credible interval 79% to 98%) and for post-herpetic neuralgia 87% (95% credible interval 65% to 96%); these numbers represent the relative risk reductions.
Although technically correct we feel it slightly misleading. We feel it would have been more appropriate to provide readers with the absolute risk reductions.
Our group recently completed a systematic review of RCTs for adjuvant, recombinant subunit herpes zoster vaccine in within which we state the absolute risk estimates. For confirmed cases of herpes zoster the absolute risk reduction for adjuvant recombinant subunit herpes zoster vaccine in immunocompetent adults is 3.54% (NNV= 28) and for post-herpetic neuralgia is 0.28% (NNV= 357). Our review also indicates that current evidence only speaks to the vaccines effects for 4 years; more evidence is needed to assess the possible durability of the effect. Our freely available review can be accessed here:
https://www.ti.ubc.ca/2018/10/10/114-shingrix-a-new-vaccine-for-shingles/.
In addition, although this indirect comparisons Bayesian analysis conforms with high methodological standards, we would have liked to have seen an assessment of the certainty of the evidence using the network meta-analysis approach.[1] The review used the outdated and NACI's methodological hierarchy which does not assess the body of the evidence for treatment comparisons.
1. Salanti G, Del Giovane C, Chaimani A, Caldwell DM, Higgins JPT. Evaluating the Quality of Evidence from a Network Meta-Analysis. PLoS ONE. 2014 Jul 3;9(7):e99682.
Competing interests: No competing interests
The great work “Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis” was published in The BMJ, comparing herpes zoster live attenuated vaccine, herpes zoster adjuvant recombinant subunit vaccine and placebo in adults aged 50 and older. Here, we have a question on the footnote of Fig 5.
It said “Each circle represents an outcome and has been sectioned into the three interventions, adjuvant, recombinant subunit herpes zoster vaccine, live attenuated herpes zoster vaccine, and placebo”, but are not adjuvant, recombinant subunit herpes zoster vaccine, live attenuated herpes zoster vaccine, and placebo 4 interventions?
Conflicts of interest
We declare that we have no conflicts of interest.
Competing interests: No competing interests
Re: Efficacy, effectiveness, and safety of herpes zoster vaccines in adults aged 50 and older: systematic review and network meta-analysis
This systematic review and network meta-analysis of all previously published research studies also concluded that "no statistically significant difference was observed between the live attenuated vaccine and placebo for incidence of laboratory confirmed herpes zoster".
Competing interests: No competing interests