Most Physicians Say Shingrix Important Development for Shingles

Alicia Ault

October 11, 2017

Three quarters of primary care physicians have never heard of Shingrix (GlaxoSmithKline), a new recombinant zoster vaccine adjuvant that could be on the United States market soon.

But after they learned about it, many were impressed by the new vaccine. The US Food and Drug Administration (FDA) is expected to make a decision about Shingrix by October 24.

The FDA's Vaccines and Related Biological Products Advisory Committee voted unanimously to back approval of the vaccine on September 13, finding it safe and effective for adults aged 50 years and older. The only currently approved herpes zoster vaccine, Zostavax (Merck), is approved by the FDA for use in adults aged 50 years and older, but it is recommended by the Centers for Disease Control and Prevention only for adults aged 60 years and older. And results of clinical trials have shown that Shingrix has greater efficacy in adults aged 70 or older.

In a Medscape Medical News survey conducted September 19-28, a majority of respondents said they had not heard of Shingrix. The respondents consisted of 80 primary care physicians, 50 nurse practitioners (NPs), and 53 physician assistants (PAs) working in family or internal medicine.

Fifteen percent of physicians said they knew basic information about the vaccine, compared with 6% of NPs and 9% of PAs. Only 5% of physicians characterized their familiarity as an understanding of the clinical data, compared with 8% of NPs and 6% of PAs.

But, after being given detailed data about the vaccine, 87% of physicians and PAs said Shingrix was an important or very important development in shingles prevention. Ninety-four percent of NPs viewed the vaccine as important or very important.

Will Shingrix Become First Option?

If Shingrix becomes available, it is likely to replace Zostavax, according to the survey. Sixty percent of all providers surveyed said they would use Shingrix before they would use Zostavax for patients older than 60. Half to two thirds of clinicians said they would also give Shingrix to patients older than 60 who had received Zostavax more than 5 years previously.

Many providers said Shingrix was important because it represented another option ― because it does not contain a live virus, it may be an option for those who cannot receive Zostavax.

Shingrix also appears to offer better efficacy, noted some respondents. "I see a lot of failures [with Zostavax]," said one doctor. And, said some, Shingrix can be given to a younger age group and offers greater efficacy in geriatric patients.

Ninety-eight percent of physicians said they anticipated using Shingrix, with most saying they would begin using it within 6 months of approval. The main reasons given for the anticipated prescribing were safety and efficacy.

Cost, Reimbursement Could Be Barriers

About 70% of all providers said that they expected that cost and reimbursement difficulties to be barriers. "It seems like it will be helpful, but I am concerned about the cost for my patients," said one physician.

A PA said that competition might improve the picture. "I believe having more than one product improves advertising, cost and patient access," said the PA.

Fifty-five percent of physicians ― and 43% of PAs and 64% of NPs ― said that prior authorization requirements were also likely to be a barrier. One NP was hopeful that the efficacy of Shingrix may "encourage more insurances to see the benefits and cover at a higher rate, if not completely, which reduces the financial burden to the recipient."

The dosing schedule ― Shingrix must be given in two doses, with a 2- to 6-month interval between ― was seen as a potential drawback by 40% of physicians and by about a quarter of NPs and PAs.

Even with some anticipated barriers, 78% of physicians said they believed the availability of Shingrix would increase the number of vaccinated patients aged 60 and older. About two thirds of NPs and PAs said vaccination rates would rise, but 40% of NPs said they thought vaccination rates would remain the same, compared with just 22% of physicians.

Physicians and PAs said only about 39% of their patients older than 60 had received Zostavax. About half of patients of NPs had been vaccinated.

A quarter to a third of the survey respondents were in an office-based single-specialty practice. Eighteen percent of physicians practiced in a hospital, 16% in an office-based multispecialty group practice, and 14% at an outpatient clinic. Twelve percent had a solo practice, and the remainder practiced in other settings.

Poll participants were recruited via email invitation. Those who completed the survey received a $50 gift card.

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