Impact of pharmacist-led shared decision-making on recombinant zoster vaccine uptake in patients receiving Janus kinase inhibitors: A single-center retrospective study

Background Janus kinase inhibitors (JAKis) are effective treatment for autoimmune diseases but are known to increase the risk of herpes zoster (HZ). Recombinant zoster vaccine (RZV) is effective in preventing HZ; nonetheless, its uptake remains suboptimal in real-world practice. This study aimed to investigate the RZV vaccination rate among patients treated with JAKis and to clarify pharmacist interventions and related factors associated with RZV uptake. Methods This single-center retrospective observational study included patients who received JAKis at our hospital between March 2020 and August 2024. Pharmacist interventions related to RZV were categorized as passive or active. In the passive intervention, physicians provided usual care independently and pharmacists became involved only upon the physicians’ request (physician group). In the active intervention, pharmacists in pharmacist-led clinics provided information on RZV at JAKi initiation and, in collaboration with physicians, recommended RZV vaccination (pharmacist-led clinic group). The primary outcome was RZV vaccination status (vaccinated vs unvaccinated) among patients treated with JAKis, whilst secondary analyses explored factors associated with RZV uptake using multivariable logistic regression. Results A total of 404 eligible patients were treated with JAKis at our institution. Following the exclusion of five patients who received zoster vaccination at other institutions, 399 patients were ultimately included in the analysis. Overall, 64 (16.0%) patients were vaccinated with RZV. Multivariate logistic regression analysis revealed that shared decision-making in pharmacist-led clinics was significantly associated with RZV vaccination. Conclusion This study suggests that effective prevention of HZ in patients treated with JAKis requires not only information provision and recommendations from healthcare professionals but also pharmacist-led shared decision-making that enables patients to understand and actively choose RZV vaccination. Establishing such systems may both reduce HZ risk and advance patient-centered care in this high-risk population.