Hospital Pharmacy - June 2018 - 136

767103
research-article2018

HPXXXX10.1177/0018578718767103Hospital PharmacyStoker et al

Formulary Drug Reviews

Zoster Vaccine Recombinant, Adjuvanted

Hospital Pharmacy
2018, Vol. 53(3) 136-141
© The Author(s) 2018
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https://doi.org/10.1177/0018578718767103
DOI: 10.1177/0018578718767103
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Kalvin Stoker1, Terri L. Levien1, and Danial E. Baker1

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Generic Name: Zoster Vaccine Recombinant, Adjuvanted
Proprietary Name: Shingrix (GlaxoSmithKline)
Approval Rating: 1B
Therapeutic Class: Vaccines
Similar Drugs: Zoster Vaccine (Live, Attenuated)
Sound-/Look-Alike Names: Shigella Vaccine, Zoster
Vaccine (Live)

Indications
Zoster vaccine recombinant, adjuvanted (Shingrix) is
approved for the prevention of herpes zoster in patients 50
years of age and older. Shingrix is not indicated for the prevention of primary varicella-zoster virus (VZV) infection
(chickenpox).1
Herpes zoster is associated with reactivation of latent VZV
after infection or live virus immunization.2,3 This reactivation
commonly presents as a unilateral vesicular skin eruption
arising in a single dermatome accompanied by pain that may
be severe or persistent. Eruptions are often preceded by a prodrome of pain or paresthesia.4 The most frequent complication of herpes zoster is postherpetic neuralgia, characterized
by persistent pain following resolution of the rash.3

Clinical Pharmacology
Shingrix is a subunit vaccine consisting of a recombinant
VZV envelope glycoprotein E antigen lyophilized component that is reconstituted at the time of use with AS01B. The
AS01B adjuvant induces a local and transient activation of
the immune system by immune enhancers 3-O-desacyl-4′monophosphoryl lipid A (MPL) (from Salmonella minnesota) and Quillaja saponaria Molina, fraction 21 (QS-21).
MPL induces signals through toll-like receptor 4; QS-21's
mechanism of action remains unknown, but its signaling is
theorized to involve activation of the NLRP3 inflammasome

complex. These 2 pathways activate antigen-presenting cells
loaded with antigen in the draining lymph node, enabling
recruitment of naive CD4+ T cells.5
Shingrix is a VZV glycoprotein E purified recombinant
protein antigen produced in Chinese hamster ovary cells.1,5
The glycoprotein E component was chosen because it is the
most abundant envelope glycoprotein expressed on the surface of virus-infected cells.5 The glycoprotein E antigen is
assisted by the AS01B adjuvant to induce the maximal frequencies of glycoprotein E-specific cytokine-producing
CD4+ T cells and the highest titers of glycoprotein E-specific
antibodies.5 The antigen remains the active ingredient and,
when paired with the AS01B adjuvant, can induce strong cellular and humoral immune responses.5 This increased reactogenicity may allow it to be used in immunocompromising
diseases (ie, HIV).2
A small study (N = 96) evaluated the immunogenicity of
Shingrix vaccine in adults 50 years and older with a history
of herpes zoster. Mean age was 64.9 years, 65.6% were
female, and 95.8% were white. All participants were seropositive for anti-glycoprotein E antibodies at baseline. One
month after the second dose, 90.2% showed a vaccine
response for anti-glycoprotein E antibodies, and the lowest
vaccine response rate was in patients whose herpes zoster
episode had occurred within the last 4 years.6

Pharmacokinetics
Pharmacokinetics data are not available for Shingrix.
1

Washington State University, Spokane, USA

Corresponding Author:
Terri L. Levien, Clinical Professor, Department of Pharmacotherapy,
College of Pharmacy, Washington State University, PO Box 1495,
Spokane, WA 99210-1495, USA.
Email: levient@wsu.edu
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