ReviewFrom the Medical Board of the National Psoriasis Foundation: Vaccination in adult patients on systemic therapy for psoriasis
Section snippets
Types of vaccines
Key points Live vaccines are relatively contraindicated in patients on immunosuppressive therapy. However, early data suggest that some live vaccines may be safe. Further studies are needed and may alter recommendations. Although inactivated vaccines are safe for patients on immunomodulatory therapy, vaccine response may be suboptimal. Additional personal and medical risk factors are important to consider in vaccine counseling.
The 2 categories of immunizations are live vaccines and inactivated vaccines (
Therapy-specific recommendations
Key points Infections are a major cause of morbidity and mortality in immunosuppressed patients. Vaccination status and advising should be incorporated in treatment of patients with moderate to severe psoriasis when immunosuppressive therapy is anticipated. Further studies are needed regarding the safety and efficacy of vaccines in patients with psoriatic disease on immunomodulatory medications to provide accurate therapy-specific immunization recommendations.
Immunization status and vaccine-preventable
Immunization of household contacts
Key points Immunization of household contacts is strongly recommended to decrease exposure to infections. Smallpox and oral polio vaccines are contraindicated in household contacts of patients on immunomodulatory medications. However, risks and benefits must be weighed when counseling on administration of other live vaccines in household contacts of profoundly immunosuppressed patients. Other live vaccines are generally recommended in household contacts of moderately immunosuppressed patients as preventing
Summary
Advances in therapeutic options for patients with psoriatic disease will hopefully continue to be a reality. Initial trials may not fully elucidate the risk of vaccine-preventable illness in patients on these emerging therapies. Postmarketing data often take time to bring such associations to light. Thus, when approaching patients with moderate to severe psoriasis, early discussion and counseling may prevent treatment delays. Dermatologists should familiarize themselves with general vaccine
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2024, Journal of the American Academy of DermatologyPractical Update of the Guidelines Published by the Psoriasis Group of the Spanish Academy of Dermatology and Venereology (GPs) on the Treatment of Psoriasis With Biologic Agents: Part 2 — Management of Special Populations, Patients With Comorbid Conditions, and Risk
2022, Actas Dermo-SifiliograficasA retrospective cohort study confirms that prophylactic vaccination is underused in patients on tumor necrosis factor inhibitors
2021, Journal of the American Academy of DermatologyA systematic review of herpes zoster incidence and consensus recommendations on vaccination in adult patients on systemic therapy for psoriasis or psoriatic arthritis: From the Medical Board of the National Psoriasis Foundation
2019, Journal of the American Academy of DermatologyCitation Excerpt :Efficacy declines with age, with 18% efficacy in adults >80 years old. The Advisory Committee on Immunization Practice, Infectious Disease Society of America, American College of Rheumatology, European League Against Rheumatism, and the NPF recommend the VZV vaccine in immunocompetent patients and in those on low-dose immunosuppression (prednisone <20 mg/day, methotrexate <0.4 mg/kg/week).13,54-57 These recommendations are based on expert opinion supported by small observational studies of the live-attenuated vaccine in patients with rheumatologic disease.58-61
Funding sources: None.
Disclosure: Dr Van Voorhees has served on advisory boards for Amgen, Abbvie, Genentech, Warner Chilcott, Janssen, Novartis, and LEO Pharma; has been an investigator and consultant for Amgen and Abbvie; and has been a speaker for Amgen, Abbvie, and Janssen Biotech. She also has owned stock and stock options for Merck. Drs Wine-Lee, Keller, Wilck, and Gluckman have no conflicts of interest to declare.