Vaccination Guidelines for Patients on Rinvoq

Introduction to Vaccine Selection

The American College of Rheumatology recommends the recombinant zoster vaccine (Shingrix) as the only appropriate option for patients on Rinvoq, as it is a non-live vaccine that is safe for immunocompromised individuals 1, 2, 3.
The live zoster vaccine (Zostavax) is absolutely contraindicated in patients receiving JAK inhibitors like upadacitinib due to the theoretical risk of disseminated vaccine-strain infection 1, 3.

Ideally, administer both doses of Shingrix before starting Rinvoq to maximize immune response 1, 3.
If vaccination must occur while on Rinvoq, the American College of Rheumatology recommends holding methotrexate (if co-administered) for 2 weeks after each vaccine dose to optimize response 1.
For patients already on Rinvoq, no modification of upadacitinib dosing is required around vaccination time 1.
The standard dosing schedule is two doses given 2-6 months apart 2, 4.

For patients over 50 years, RZV is recommended regardless of prior herpes zoster history 2, 4.
For immunocompromised adults aged 18-49 years at increased risk, RZV can be given with a shortened schedule (1-2 months between doses) 2, 4.
Patients who previously received Zostavax should still receive the full 2-dose Shingrix series, with at least 2 months between the last Zostavax dose and first Shingrix dose 2, 4.

Verify vaccine type: Confirm Shingrix (RZV), not Zostavax (ZVL) 1, 3.
Check vaccination history: If never vaccinated, proceed with 2-dose series 2, 4.
Optimize timing: Give before starting Rinvoq if possible; if already on Rinvoq, proceed without delay 1, 3.
Manage concomitant methotrexate: Hold for 2 weeks after each dose if co-administered 1.
Maintain upadacitinib: Continue without interruption 1.