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

Impact of pharmacist-led shared decision-making on recombinant zoster vaccine uptake in patients receiving Janus kinase inhibitors: A single-center retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of pharmacist-led shared decision-making on recombinant zoster vaccine uptake in patients receiving Janus kinase inhibitors: A single-center retrospective study Hiroki Oba, Ikkou Hirata, Ryuichi Okazaki, Ryo Rokutanda, Ryohkan Funakoshi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8434152/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Janus kinase inhibitor Recombinant zoster vaccine Autoimmune disease Outpatient pharmaceutical clinic Inflammatory immune disease Pharmacological management Background Herpes zoster (HZ) results from the reactivation of the varicella-zoster virus and can lead to postherpetic neuralgia, markedly impairing patients’ quality of life [ 1 ]. Older adults and patients receiving immunosuppressive therapy are at a particularly high risk of HZ development; thus, vaccination is emphasized as an important preventive strategy in this population [ 2 ]. The recombinant zoster vaccine (RZV) has been reported to reduce the incidence of HZ by > 90% with a two-dose schedule and to maintain high efficacy for > 10 years after vaccination [ 3 ]. RZV was initially approved for use in immunocompetent adults aged ≥ 50 years; however, its indication has been expanded to include immunocompromised adults. Additionally, the American College of Rheumatology guidelines recommend RZV for patients aged ≥ 18 years treated with immunosuppressive drugs [ 4 ]. Janus kinase inhibitors (JAKis) are effective treatment for various immune-mediated diseases, including rheumatoid arthritis, ulcerative colitis, and atopic dermatitis. Nevertheless, JAKis reportedly increase the HZ risk because they interfere with cytokine signaling pathways involved in the control of varicella-zoster virus reactivation [ 5 ]. Recently, accumulative evidence has suggested that the involvement of pharmacists in patient education, vaccine recommendations, and follow-ups improves the uptake of several vaccines, including influenza and pneumococcal vaccines [ 6 ]. Nonetheless, the impact of pharmacist interventions and shared decision-making on RZV uptake in patients treated with JAKis has not been fully investigated. Therefore, the present study aimed to examine the RZV vaccination rate among patients treated with JAKis and to identify pharmacist interventions (including shared decision-making in pharmacist-led clinics) and other factors associated with RZV uptake. Methods Study design, patients, and study period This single-center retrospective observational study included patients who were treated with JAKis at Kameda Clinic (Kamogawa, Chiba, Japan) from March 2020 to August 2024. Patients who received any HZ vaccine at another medical institution were excluded. The study period was defined from March 2020, when RZV vaccination became available at Kameda Clinic. In Japan, adults aged ≥ 65 years became eligible for routine RZV vaccination in April 2025, and some municipalities had introduced their own financial subsidy programs for RZV vaccination even before routine vaccination was implemented [ 7 ]. However, in the present study, the analysis was limited to the period prior to the implementation of the routine vaccination program. Pharmacist interventions related to RZV vaccination were categorized into passive and active interventions. With the passive intervention, physicians provided usual care independently, and pharmacists became involved only upon the physicians’ request (physician group). With the active intervention, pharmacists in pharmacist-led clinics provided information on RZV vaccination at the time of JAKi treatment initiation and recommended RZV vaccination in collaboration with physicians (outpatient pharmaceutical clinic group). Pharmacist-led clinics were run in the Department of Rheumatology, Collagen Disease, and Allergy and in the inflammatory bowel disease specialty clinic of the Department of Gastroenterology. In these clinics, pharmacists conducted patient interviews prior to physician visit, made proposals regarding the initiation or continuation of JAKi treatment, and provided information on and recommendations for RZV vaccination using manufacturer-prepared patient educational materials [ 8 ]. Furthermore, as part of pharmacotherapy management, pharmacists systematically assessed potential barriers (e.g., concerns about the effectiveness of vaccines, benefits of vaccination, and financial burden), subsequently offered neutral and detailed explanations tailored to each patient’s individual HZ risk and barriers, and implemented shared decision-making while considering patients’ values [ 9 ]. Data on patient characteristics and pharmacist interventions were retrospectively extracted from electronic medical records. Outcomes The primary outcome was the RZV vaccination rate among patients treated with JAKis. The secondary outcome was the identification of factors associated with RZV uptake. Statistical analysis Categorical and continuous variables were compared using the chi-square test and Mann–Whitney U test, respectively. A multivariate logistic regression analysis was conducted to adjust for potential confounding factors influencing the primary outcome., The following covariates considered to be clinically relevant to RZV uptake were included: age, sex, history of HZ, atopic dermatitis, specific JAKis used, and presence or absence of shared decision-making. All statistical analyses were performed using R version 4.4.3 (R Foundation for Statistical Computing, Vienna, Austria), with statistical significance set at p < 0.05. Ethical considerations This study was conducted in accordance with the Declaration of Helsinki, Ethical Guidelines for Medical and Biological Research Involving Human Subjects in Japan, and Guidance on the Proper Handling of Personal Information by Medical and Nursing Care Service Providers. The study protocol was approved by the Clinical Research Review Board of Kameda General Hospital (approval no. 24–146). Results A total of 404 patients were treated with JAKis during the study period. After excluding five patients who received zoster vaccination at other institutions, 399 patients were ultimately included in the analysis, among whom 64 (16.0%) received at least one dose of RZV (Table 1 ). Among the vaccinated patients, seven (10.9%) received only the first dose, whereas 57 (89.1%) completed the two-dose series. In seven patients who discontinued after the first dose, the second dose was not administered because of post-vaccination symptoms, such as nausea and rashes. The proportion of women in the vaccinated group was significantly higher than that in the unvaccinated group (84.4% vs. 64.8%, p < 0.05). Table 1 Baseline characteristics of patients according to RZV vaccination status Vaccinated Unvaccinated p -value n 64 335 Age, median [range] 72.50 [58.00, 77.25] 66.00 [49.00, 77.00] < 0.05 Female sex 54 (84.4) 217 (64.8) < 0.05 RZV, one dose 7 (10.9) 0 (0.0) < 0.05 RZV, two doses 57 (89.1) 0 (0.0) < 0.05 Outpatient pharmaceutical clinic group 61 (95.3) 248 (74.0) < 0.05 Shared decision-making 16 (25.0) 29 (8.7) < 0.05 Physician-only group 3 (4.7) 87 (26.0) < 0.05 Disease Atopic dermatitis 2 (3.1) 58 (17.3) < 0.05 Alopecia areata 1 (1.6) 27 (8.1) 0.06 Ulcerative colitis 1 (1.6) 16 (4.8) 0.33 Rheumatoid arthritis 59 (92.2) 225 (67.2) < 0.05 Psoriatic arthritis 0 (0.0) 5 (1.5) 1.00 Giant cell arteritis 1 (1.6) 2 (0.6) 0.41 Juvenile idiopathic arthritis 0 (0.0) 1 (0.3) 1.00 Spondyloarthritis 0 (0.0) 2 (0.6) 1.00 History of herpes zoster 11 (17.2) 58 (17.3) 1.00 Janus kinase inhibitors Baricitinib 46 (71.9) 208 (62.1) 0.16 Filgotinib 17 (26.6) 43 (12.8) < 0.05 Upadacitinib 27 (42.2) 140 (41.8) 1.00 Count, % Regarding underlying diseases, the RZV vaccination rate was higher in patients with rheumatoid arthritis (92.2% vs 67.2%, p < 0.05), whereas it was lower in those with atopic dermatitis (3.1% vs 17.3%, p < 0.05). No significant differences in the vaccination rate were observed for other diseases. Similarly, a history of HZ was not associated with a significant difference in RZV uptake. Regarding individual JAK inhibitors, the proportion of patients receiving filgotinib was significantly higher in the vaccinated group compared with the unvaccinated group (26.6% vs 12.8%, p < 0.05). No significant differences were found for baricitinib and upadacitinib. Multivariate logistic regression analysis revealed that shared decision-making was positively associated with RZV vaccination (odds ratio [OR]: 2.69, 95% confidence interval [CI]: 1.31–5.54, p < 0.05). Additionally, female sex (OR: 2.25, 95% CI: 1.07–4.72, p < 0.05) and filgotinib use (OR: 2.60, 95% CI: 1.20–5.65, p < 0.05) were significantly associated with RZV uptake (Table 2 ). Table 2 Multivariate logistic regression analysis of factors associated with RZV vaccination OR 95% CI p- value (Intercept) 0.04 0.01 0.10 < 0.05 Shared decision-making 2.69 1.31 5.54 < 0.05 Age ≥ 65 years 1.38 0.75 2.53 0.31 Female sex 2.25 1.07 4.72 < 0.05 History of herpes zoster 2.10 1.00 4.43 0.05 Atopic dermatitis 0.31 0.07 1.42 0.13 Baricitinib 1.97 0.94 4.12 0.07 Upadacitinib 1.67 0.90 3.10 0.10 Filgotinib 2.60 1.20 5.65 < 0.05 OR, odds ratio; CI, confidence interval Regardless of vaccination status, all patients who participated in SDM testified that they were satisfied with the process. Discussion This study revealed that the provision of RZV-related information at the time of JAKi treatment initiation by pharmacists in collaboration with physicians was associated with a higher RZV vaccination rate than conventional physician-only care. Notably, the intervention involving shared decision-making in pharmacist-led clinics markedly affected RZV uptake, and, regardless of vaccination status, all patients who participated in SDM reported being satisfied with the process. The multivariate analysis showed that patients involved in shared decision-making had significantly higher odds of receiving RZV vaccination than those not involved in shared decision-making (OR: 2.69), suggesting that the process of sharing decisions between patients and healthcare professionals facilitates vaccine acceptance. A recent meta-analysis reported that shared decision-making significantly increased vaccine uptake by approximately 1.45-fold across various vaccine types [ 10 ]. Additionally, a previous report indicated that shared decision-making reduced decisional conflict and improved the confidence of patients in their choices [ 10 ]. In the context of vaccination, individual values, concerns, and hesitations often underlie patients’ reluctance or ambivalence toward immunization [ 11 ]. Shared decision-making encourages healthcare professionals to listen carefully to these concerns, provide evidence-based information, and align recommendations with the patients’ values, thereby enabling patients to reach informed and satisfactory decisions [ 10 ]. In our setting, shared decision-making implemented in pharmacist-led clinics created opportunities to complement physicians’ explanations and address patients’ individual questions in detail, which likely shifted the basis for vaccination from a passive stance (i.e., “I will get vaccinated because my healthcare provider recommended it”) toward an active stance (i.e., “I choose to be vaccinated because I am convinced”), resulting in a more autonomous behavioral change. Such process is crucial for improving the vaccination rate and fostering patients’ engagement in their own treatment. This study also revealed that female sex and filgotinib use were significantly associated with RZV vaccination. With respect to sex differences, previous studies on the general adult population reported slightly higher HZ vaccine uptake among women, possibly reflecting greater interest in preventive care and higher utilization of healthcare services among female patients [ 12 ]. Given that women account for a large proportion of patients with rheumatic diseases, this association may, at least in part, be attributable to differences in the underlying patient population [ 13 ]. Regarding filgotinib use, treatment with filgotinib, a selective JAK1 inhibitor, was associated with a higher likelihood of RZV vaccination. The HZ risk associated with filgotinib has been reported to be lower than that with other JAKis; thus, filgotinib may be preferentially selected for patients with a particularly concerning infection risk in clinical practice [ 5 ]. As these patients remain immunosuppressed, they have a higher need for preventive strategies. It is plausible that when prescribing filgotinib, clinicians are more likely to reconsider and proactively propose RZV vaccination. However, owing to the observational nature of this study, the causal relationship underlying this association remains unclear and requires further investigation. This study had three main limitations. First, this single-center retrospective observational study had a limited sample size and observation period. Consequently, the generalizability of our findings is limited. Multicenter prospective studies should be conducted to establish robust and widely applicable evidence supporting RZV vaccination prior to the initiation of anticancer chemotherapy. Additionally, future research should investigate the effects of pharmacist interventions in pharmacist-led oncology clinics. Second, this study focused on patients treated with JAKis, and the study population consequently comprised individuals with rheumatological and dermatological diseases. Atopic dermatitis reportedly increases the HZ risk through skin barrier dysfunction and immunological abnormalities, and JAKi treatment for dermatologic conditions such as alopecia areata may further increase this risk; therefore, RZV vaccination is recommended in these patients [ 14 , 15 ]. Similarly, in rheumatology, JAKi treatment is associated with an elevated HZ risk, and the magnitude of this risk may differ across individual JAKis [ 5 ]. Taken together, differences in disease composition and choice of JAKis are likely to influence patient and clinician decisions regarding vaccination and may partially account for the observed between-group difference in the vaccination rate. Third, during the study period, some local governments in Japan implemented independent subsidy programs for RZV prior to its inclusion in the national routine immunization schedule [ 7 ]. However, in Kamogawa City, Chiba Prefecture, where Kameda Clinic is located, public subsidy for herpes zoster vaccination did not begin until April 2025, and no municipal subsidy was available during the study period. Consequently, RZV uptake in this cohort largely reflected patients’ decisions under out-of-pocket payment, allowing us to evaluate the impact of pharmacist-led clinics and SDM with minimal distortion by local subsidy programs, which can be regarded as a strength of this study. On the other hand, caution is warranted when generalizing our findings to settings with generous public subsidies. Future studies that more precisely capture municipal subsidy schemes and individual-level out-of-pocket costs, while concurrently evaluating economic factors and pharmacist interventions, may help to inform more effective strategies to promote vaccination. Conclusions The findings of this study suggest that effective prevention of HZ in patients treated with JAKis requires not only the provision of information and recommendations by healthcare professionals, as has been emphasized previously [ 11 , 16 ], but also shared decision-making between patients and pharmacists. Establishing a system that enables patients to understand and actively choose preventive measures is crucial for reducing the HZ risk and advancing patient-centered care. This study provides useful insights into the role of pharmacist-led shared decision-making in promoting RZV vaccination in this high-risk population. Abbreviations CI Confidence interval HZ Herpes zoster JAKi Janus kinase inhibitors OR Odds ratio RZV Recombinant zoster vaccine Declarations Ethics approval and consent to participate The study protocol was approved by the Clinical Research Review Board of Kameda General Hospital (approval no. 24–146). The requirement for the acquisition of informed consent from patients was waived owing to the retrospective nature of this study. Consent for publication Not applicable. Competing interests The authors declare no conflict of interest. Funding This study did not receive funding from any funding source. Author Contribution Conceptualization: H.O., I.H., R.O., R.R., R.F.; Methodology: H.O., I.H.; Data Collection and Analysis: H.O., I.H., R.O.; Writing - Original Draft: H.O.; Writing – Review & Editing: I.H., R.O., R.R., R.F.; Project Administration: R.F.All authors read and approved the final manuscript. Acknowledgements Not applicable. Data Availability The datasets used and analyzed in this study are available from the corresponding author on reasonable request. References Herpes Zoster Clinical Practice Guideline Committee, Japanese Dermatological Association. Herpes zoster clinical practice guidelines 2025. Jpn J Dermatol. 2025;135:527–56. Curran D, Doherty TM, Lecrenier N, Breuer T. Healthy ageing: Herpes zoster infection and the role of zoster vaccination. NPJ Vaccines. 2023;8:184. Strezova A, Diez-Domingo J, Al Shawafi K, Tinoco JC, Shi M, Pirrotta P, et al. Long-term protection against herpes zoster by the adjuvanted recombinant zoster vaccine: interim efficacy, immunogenicity, and safety results up to 10 years after initial vaccination. Open Forum Infect Dis. 2022;9:ofac485. Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79:39–52. Xu Q, He L, Yin Y. Risk of herpes zoster associated with JAK inhibitors in immune-mediated inflammatory diseases: a systematic review and network meta-analysis. Front Pharmacol. 2023;14:1241954. Le LM, Veettil SK, Donaldson D, Kategeaw W, Hutubessy R, Lambach P et al. The impact of pharmacist involvement on immunization uptake and other outcomes: An updated systematic review and meta-analysis. J Am Pharm Assoc (2003). 2022;62:1499–513.e16. Shono A, Hoshi SL, Kondo M. Subsidy programs for herpes zoster vaccination in Japanese municipalities. Biol Pharm Bull. 2025;48:1185–90. Oba H, Hirata I, Inoue M, Ogura C, Mori K, Rokutanda R, Funakoshi R. Effectiveness of Outpatient Pharmaceutical Clinics in the Overseeing of Self-Injectable Biologic Prescriptions for Inflammatory Immune Diseases and the Cost-Effectiveness of Pharmacological Management. Biol Pharm Bull. 2025;48:1864–71. Hirata I, Hanaoka S, Rokutanda R, Funakoshi R, Hayashi H. Shared decision-making practices and patient values in pharmacist outpatient care for rheumatic disease: A multiple correspondence analysis. J Pharm Pharm Sci. 2023;26:11135. Scalia P, Durand MA, Elwyn G. Shared decision-making interventions: An overview and a meta-analysis of their impact on vaccine uptake. J Intern Med. 2022;291:408–25. Wang Q, Yang L, Li L, Liu C, Jin H, Lin L. Willingness to vaccinate against herpes zoster and its associated factors across WHO regions: global systematic review and meta-analysis. JMIR Public Health Surveill. 2023;9:e43893. Wang X, Shang S, Zhang E, Dai Z, Xing Y, Hu J, et al. Unraveling herpes zoster vaccine hesitancy, acceptance, and its predictors: insights from a scoping review. Public Health Rev. 2024;45:1606679. Quintero OL, Amador-Patarroyo MJ, Montoya-Ortiz G, Rojas-Villarraga A, Anaya JM. Autoimmune disease and gender: plausible mechanisms for the female predominance of autoimmunity. J Autoimmun. 2012;38:J109–19. Wu SE, Chen YH, Chung CH, Wu GJ, Tsao CH, Sun CA, et al. Atopic dermatitis as a risk factor for herpes zoster infection independent of treatment: a nationwide population-based cohort study. Dermatitis. 2023;34:241–9. Ireland PA, Verheyden M, Jansson N, Sebaratnam D, Sullivan J. Infection risk with JAK inhibitors in dermatoses: a meta-analysis. Int J Dermatol. 2025;64:24–36. Yang TU, Cheong HJ, Song JY, Noh JY, Kim WJ. Survey on public awareness, attitudes, and barriers for herpes zoster vaccination in South Korea. Hum Vaccin Immunother. 2015;11:719–26. 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Older adults and patients receiving immunosuppressive therapy are at a particularly high risk of HZ development; thus, vaccination is emphasized as an important preventive strategy in this population [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The recombinant zoster vaccine (RZV) has been reported to reduce the incidence of HZ by \u0026gt;\u0026thinsp;90% with a two-dose schedule and to maintain high efficacy for \u0026gt;\u0026thinsp;10 years after vaccination [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. RZV was initially approved for use in immunocompetent adults aged\u0026thinsp;\u0026ge;\u0026thinsp;50 years; however, its indication has been expanded to include immunocompromised adults. Additionally, the American College of Rheumatology guidelines recommend RZV for patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years treated with immunosuppressive drugs [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eJanus kinase inhibitors (JAKis) are effective treatment for various immune-mediated diseases, including rheumatoid arthritis, ulcerative colitis, and atopic dermatitis. Nevertheless, JAKis reportedly increase the HZ risk because they interfere with cytokine signaling pathways involved in the control of varicella-zoster virus reactivation [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecently, accumulative evidence has suggested that the involvement of pharmacists in patient education, vaccine recommendations, and follow-ups improves the uptake of several vaccines, including influenza and pneumococcal vaccines [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Nonetheless, the impact of pharmacist interventions and shared decision-making on RZV uptake in patients treated with JAKis has not been fully investigated.\u003c/p\u003e \u003cp\u003eTherefore, the present study aimed to examine the RZV vaccination rate among patients treated with JAKis and to identify pharmacist interventions (including shared decision-making in pharmacist-led clinics) and other factors associated with RZV uptake.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design, patients, and study period\u003c/h2\u003e \u003cp\u003eThis single-center retrospective observational study included patients who were treated with JAKis at Kameda Clinic (Kamogawa, Chiba, Japan) from March 2020 to August 2024. Patients who received any HZ vaccine at another medical institution were excluded. The study period was defined from March 2020, when RZV vaccination became available at Kameda Clinic. In Japan, adults aged\u0026thinsp;\u0026ge;\u0026thinsp;65 years became eligible for routine RZV vaccination in April 2025, and some municipalities had introduced their own financial subsidy programs for RZV vaccination even before routine vaccination was implemented [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, in the present study, the analysis was limited to the period prior to the implementation of the routine vaccination program.\u003c/p\u003e \u003cp\u003ePharmacist interventions related to RZV vaccination were categorized into passive and active interventions. With the passive intervention, physicians provided usual care independently, and pharmacists became involved only upon the physicians\u0026rsquo; request (physician group). With the active intervention, pharmacists in pharmacist-led clinics provided information on RZV vaccination at the time of JAKi treatment initiation and recommended RZV vaccination in collaboration with physicians (outpatient pharmaceutical clinic group). Pharmacist-led clinics were run in the Department of Rheumatology, Collagen Disease, and Allergy and in the inflammatory bowel disease specialty clinic of the Department of Gastroenterology. In these clinics, pharmacists conducted patient interviews prior to physician visit, made proposals regarding the initiation or continuation of JAKi treatment, and provided information on and recommendations for RZV vaccination using manufacturer-prepared patient educational materials [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Furthermore, as part of pharmacotherapy management, pharmacists systematically assessed potential barriers (e.g., concerns about the effectiveness of vaccines, benefits of vaccination, and financial burden), subsequently offered neutral and detailed explanations tailored to each patient\u0026rsquo;s individual HZ risk and barriers, and implemented shared decision-making while considering patients\u0026rsquo; values [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eData on patient characteristics and pharmacist interventions were retrospectively extracted from electronic medical records.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was the RZV vaccination rate among patients treated with JAKis. The secondary outcome was the identification of factors associated with RZV uptake.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eCategorical and continuous variables were compared using the chi-square test and Mann\u0026ndash;Whitney U test, respectively. A multivariate logistic regression analysis was conducted to adjust for potential confounding factors influencing the primary outcome., The following covariates considered to be clinically relevant to RZV uptake were included: age, sex, history of HZ, atopic dermatitis, specific JAKis used, and presence or absence of shared decision-making. All statistical analyses were performed using R version 4.4.3 (R Foundation for Statistical Computing, Vienna, Austria), with statistical significance set at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki, Ethical Guidelines for Medical and Biological Research Involving Human Subjects in Japan, and Guidance on the Proper Handling of Personal Information by Medical and Nursing Care Service Providers. The study protocol was approved by the Clinical Research Review Board of Kameda General Hospital (approval no. 24\u0026ndash;146).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 404 patients were treated with JAKis during the study period. After excluding five patients who received zoster vaccination at other institutions, 399 patients were ultimately included in the analysis, among whom 64 (16.0%) received at least one dose of RZV (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among the vaccinated patients, seven (10.9%) received only the first dose, whereas 57 (89.1%) completed the two-dose series. In seven patients who discontinued after the first dose, the second dose was not administered because of post-vaccination symptoms, such as nausea and rashes. The proportion of women in the vaccinated group was significantly higher than that in the unvaccinated group (84.4% vs. 64.8%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics of patients according to RZV vaccination status\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVaccinated\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eUnvaccinated\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, median [range]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72.50 [58.00, 77.25]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.00 [49.00, 77.00]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54 (84.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e217 (64.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRZV, one dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRZV, two doses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57 (89.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutpatient pharmaceutical clinic group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61 (95.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e248 (74.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShared decision-making\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysician-only group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (4.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87 (26.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtopic dermatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlopecia areata\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27 (8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUlcerative colitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRheumatoid arthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (92.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e225 (67.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsoriatic arthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGiant cell arteritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.41\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJuvenile idiopathic arthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpondyloarthritis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of herpes zoster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJanus kinase inhibitors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaricitinib\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (71.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e208 (62.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFilgotinib\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (26.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43 (12.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpadacitinib\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (42.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (41.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCount, %\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegarding underlying diseases, the RZV vaccination rate was higher in patients with rheumatoid arthritis (92.2% vs 67.2%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), whereas it was lower in those with atopic dermatitis (3.1% vs 17.3%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences in the vaccination rate were observed for other diseases. Similarly, a history of HZ was not associated with a significant difference in RZV uptake.\u003c/p\u003e \u003cp\u003eRegarding individual JAK inhibitors, the proportion of patients receiving filgotinib was significantly higher in the vaccinated group compared with the unvaccinated group (26.6% vs 12.8%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences were found for baricitinib and upadacitinib.\u003c/p\u003e \u003cp\u003eMultivariate logistic regression analysis revealed that shared decision-making was positively associated with RZV vaccination (odds ratio [OR]: 2.69, 95% confidence interval [CI]: 1.31\u0026ndash;5.54, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Additionally, female sex (OR: 2.25, 95% CI: 1.07\u0026ndash;4.72, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) and filgotinib use (OR: 2.60, 95% CI: 1.20\u0026ndash;5.65, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05) were significantly associated with RZV uptake (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression analysis of factors associated with RZV vaccination\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003ep-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Intercept)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eShared decision-making\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;65 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale sex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of herpes zoster\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAtopic dermatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBaricitinib\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpadacitinib\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFilgotinib\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eOR, odds ratio; CI, confidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRegardless of vaccination status, all patients who participated in SDM testified that they were satisfied with the process.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study revealed that the provision of RZV-related information at the time of JAKi treatment initiation by pharmacists in collaboration with physicians was associated with a higher RZV vaccination rate than conventional physician-only care. Notably, the intervention involving shared decision-making in pharmacist-led clinics markedly affected RZV uptake, and, regardless of vaccination status, all patients who participated in SDM reported being satisfied with the process.\u003c/p\u003e \u003cp\u003eThe multivariate analysis showed that patients involved in shared decision-making had significantly higher odds of receiving RZV vaccination than those not involved in shared decision-making (OR: 2.69), suggesting that the process of sharing decisions between patients and healthcare professionals facilitates vaccine acceptance. A recent meta-analysis reported that shared decision-making significantly increased vaccine uptake by approximately 1.45-fold across various vaccine types [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Additionally, a previous report indicated that shared decision-making reduced decisional conflict and improved the confidence of patients in their choices [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In the context of vaccination, individual values, concerns, and hesitations often underlie patients\u0026rsquo; reluctance or ambivalence toward immunization [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Shared decision-making encourages healthcare professionals to listen carefully to these concerns, provide evidence-based information, and align recommendations with the patients\u0026rsquo; values, thereby enabling patients to reach informed and satisfactory decisions [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our setting, shared decision-making implemented in pharmacist-led clinics created opportunities to complement physicians\u0026rsquo; explanations and address patients\u0026rsquo; individual questions in detail, which likely shifted the basis for vaccination from a passive stance (i.e., \u0026ldquo;I will get vaccinated because my healthcare provider recommended it\u0026rdquo;) toward an active stance (i.e., \u0026ldquo;I choose to be vaccinated because I am convinced\u0026rdquo;), resulting in a more autonomous behavioral change. Such process is crucial for improving the vaccination rate and fostering patients\u0026rsquo; engagement in their own treatment.\u003c/p\u003e \u003cp\u003eThis study also revealed that female sex and filgotinib use were significantly associated with RZV vaccination. With respect to sex differences, previous studies on the general adult population reported slightly higher HZ vaccine uptake among women, possibly reflecting greater interest in preventive care and higher utilization of healthcare services among female patients [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Given that women account for a large proportion of patients with rheumatic diseases, this association may, at least in part, be attributable to differences in the underlying patient population [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Regarding filgotinib use, treatment with filgotinib, a selective JAK1 inhibitor, was associated with a higher likelihood of RZV vaccination. The HZ risk associated with filgotinib has been reported to be lower than that with other JAKis; thus, filgotinib may be preferentially selected for patients with a particularly concerning infection risk in clinical practice [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As these patients remain immunosuppressed, they have a higher need for preventive strategies. It is plausible that when prescribing filgotinib, clinicians are more likely to reconsider and proactively propose RZV vaccination. However, owing to the observational nature of this study, the causal relationship underlying this association remains unclear and requires further investigation.\u003c/p\u003e \u003cp\u003eThis study had three main limitations. First, this single-center retrospective observational study had a limited sample size and observation period. Consequently, the generalizability of our findings is limited. Multicenter prospective studies should be conducted to establish robust and widely applicable evidence supporting RZV vaccination prior to the initiation of anticancer chemotherapy. Additionally, future research should investigate the effects of pharmacist interventions in pharmacist-led oncology clinics.\u003c/p\u003e \u003cp\u003eSecond, this study focused on patients treated with JAKis, and the study population consequently comprised individuals with rheumatological and dermatological diseases. Atopic dermatitis reportedly increases the HZ risk through skin barrier dysfunction and immunological abnormalities, and JAKi treatment for dermatologic conditions such as alopecia areata may further increase this risk; therefore, RZV vaccination is recommended in these patients [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Similarly, in rheumatology, JAKi treatment is associated with an elevated HZ risk, and the magnitude of this risk may differ across individual JAKis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Taken together, differences in disease composition and choice of JAKis are likely to influence patient and clinician decisions regarding vaccination and may partially account for the observed between-group difference in the vaccination rate.\u003c/p\u003e \u003cp\u003eThird, during the study period, some local governments in Japan implemented independent subsidy programs for RZV prior to its inclusion in the national routine immunization schedule [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, in Kamogawa City, Chiba Prefecture, where Kameda Clinic is located, public subsidy for herpes zoster vaccination did not begin until April 2025, and no municipal subsidy was available during the study period. Consequently, RZV uptake in this cohort largely reflected patients\u0026rsquo; decisions under out-of-pocket payment, allowing us to evaluate the impact of pharmacist-led clinics and SDM with minimal distortion by local subsidy programs, which can be regarded as a strength of this study. On the other hand, caution is warranted when generalizing our findings to settings with generous public subsidies. Future studies that more precisely capture municipal subsidy schemes and individual-level out-of-pocket costs, while concurrently evaluating economic factors and pharmacist interventions, may help to inform more effective strategies to promote vaccination.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe findings of this study suggest that effective prevention of HZ in patients treated with JAKis requires not only the provision of information and recommendations by healthcare professionals, as has been emphasized previously [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], but also shared decision-making between patients and pharmacists. Establishing a system that enables patients to understand and actively choose preventive measures is crucial for reducing the HZ risk and advancing patient-centered care. This study provides useful insights into the role of pharmacist-led shared decision-making in promoting RZV vaccination in this high-risk population.\u003c/p\u003e"},{"header":"Abbreviations","content":" \u003cp\u003eCI Confidence interval\u003c/p\u003e \u003cp\u003eHZ Herpes zoster\u003c/p\u003e \u003cp\u003eJAKi Janus kinase inhibitors\u003c/p\u003e \u003cp\u003eOR Odds ratio\u003c/p\u003e \u003cp\u003eRZV Recombinant zoster vaccine\u003c/p\u003e \u003c/p\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eThe study protocol was approved by the Clinical Research Review Board of Kameda General Hospital (approval no. 24\u0026ndash;146). The requirement for the acquisition of informed consent from patients was waived owing to the retrospective nature of this study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eCompeting interests\u003c/h2\u003e \u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eThis study did not receive funding from any funding source.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization: H.O., I.H., R.O., R.R., R.F.; Methodology: H.O., I.H.; Data Collection and Analysis: H.O., I.H., R.O.; Writing - Original Draft: H.O.; Writing \u0026ndash; Review \u0026amp; Editing: I.H., R.O., R.R., R.F.; Project Administration: R.F.All authors read and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eNot applicable.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and analyzed in this study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHerpes Zoster Clinical Practice Guideline Committee, Japanese Dermatological Association. Herpes zoster clinical practice guidelines 2025. Jpn J Dermatol. 2025;135:527\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCurran D, Doherty TM, Lecrenier N, Breuer T. Healthy ageing: Herpes zoster infection and the role of zoster vaccination. NPJ Vaccines. 2023;8:184.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStrezova A, Diez-Domingo J, Al Shawafi K, Tinoco JC, Shi M, Pirrotta P, et al. Long-term protection against herpes zoster by the adjuvanted recombinant zoster vaccine: interim efficacy, immunogenicity, and safety results up to 10 years after initial vaccination. Open Forum Infect Dis. 2022;9:ofac485.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFurer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M, et al. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020;79:39\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu Q, He L, Yin Y. Risk of herpes zoster associated with JAK inhibitors in immune-mediated inflammatory diseases: a systematic review and network meta-analysis. Front Pharmacol. 2023;14:1241954.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLe LM, Veettil SK, Donaldson D, Kategeaw W, Hutubessy R, Lambach P et al. The impact of pharmacist involvement on immunization uptake and other outcomes: An updated systematic review and meta-analysis. J Am Pharm Assoc (2003). 2022;62:1499\u0026ndash;513.e16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShono A, Hoshi SL, Kondo M. Subsidy programs for herpes zoster vaccination in Japanese municipalities. Biol Pharm Bull. 2025;48:1185\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOba H, Hirata I, Inoue M, Ogura C, Mori K, Rokutanda R, Funakoshi R. Effectiveness of Outpatient Pharmaceutical Clinics in the Overseeing of Self-Injectable Biologic Prescriptions for Inflammatory Immune Diseases and the Cost-Effectiveness of Pharmacological Management. Biol Pharm Bull. 2025;48:1864\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHirata I, Hanaoka S, Rokutanda R, Funakoshi R, Hayashi H. Shared decision-making practices and patient values in pharmacist outpatient care for rheumatic disease: A multiple correspondence analysis. J Pharm Pharm Sci. 2023;26:11135.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eScalia P, Durand MA, Elwyn G. Shared decision-making interventions: An overview and a meta-analysis of their impact on vaccine uptake. J Intern Med. 2022;291:408\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Q, Yang L, Li L, Liu C, Jin H, Lin L. Willingness to vaccinate against herpes zoster and its associated factors across WHO regions: global systematic review and meta-analysis. JMIR Public Health Surveill. 2023;9:e43893.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Shang S, Zhang E, Dai Z, Xing Y, Hu J, et al. Unraveling herpes zoster vaccine hesitancy, acceptance, and its predictors: insights from a scoping review. Public Health Rev. 2024;45:1606679.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQuintero OL, Amador-Patarroyo MJ, Montoya-Ortiz G, Rojas-Villarraga A, Anaya JM. Autoimmune disease and gender: plausible mechanisms for the female predominance of autoimmunity. J Autoimmun. 2012;38:J109\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu SE, Chen YH, Chung CH, Wu GJ, Tsao CH, Sun CA, et al. Atopic dermatitis as a risk factor for herpes zoster infection independent of treatment: a nationwide population-based cohort study. Dermatitis. 2023;34:241\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIreland PA, Verheyden M, Jansson N, Sebaratnam D, Sullivan J. Infection risk with JAK inhibitors in dermatoses: a meta-analysis. Int J Dermatol. 2025;64:24\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang TU, Cheong HJ, Song JY, Noh JY, Kim WJ. Survey on public awareness, attitudes, and barriers for herpes zoster vaccination in South Korea. Hum Vaccin Immunother. 2015;11:719\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Janus kinase inhibitor, Recombinant zoster vaccine, Autoimmune disease, Outpatient pharmaceutical clinic, Inflammatory immune disease, Pharmacological management","lastPublishedDoi":"10.21203/rs.3.rs-8434152/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8434152/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eJanus 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis 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\u0026rsquo; 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA 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.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis 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.\u003c/p\u003e","manuscriptTitle":"Impact of pharmacist-led shared decision-making on recombinant zoster vaccine uptake in patients receiving Janus kinase inhibitors: A single-center retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-06 19:23:27","doi":"10.21203/rs.3.rs-8434152/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dcf4874d-9e32-4dbf-9b9e-5e7cfee422b3","owner":[],"postedDate":"January 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-19T03:39:34+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-06 19:23:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8434152","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8434152","identity":"rs-8434152","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}