Vaccinations and biologics: What you need to know
Although it is recommended that people with lupus receive most standard vaccinations, no specific recommendations exist with respect to how the new biologic medications may affect the safety and efficacy of these vaccinations. Isabel Ferreira, M.D., of Hospital Prof. Doutor Fernando Fonseca, in Amadora, Portugal, and David Isenberg, M.D., of the Centre for Rheumatology, University College of London, United Kingdom, conducted a literature search and analysis to try to provide some guidelines.
Why are people with lupus more susceptible to infections?
For two reasons. First, because there are faults within their immune (protective) system as a consequence of the disease. Second, because the steroid and immunosuppressive drugs used as treatments have the side effect of reducing the body's ability to protect itself against infection.
Why is it so difficult to predict how people with lupus will react to vaccinations?
Most people with lupus “react” normally. The real question is to what extent the degree of protection against the individual bacterium/virus is compromised by the disease and its treatment, and that is much harder to answer.
What are the current vaccination recommendations for people with lupus taking biologic medications?
The absence of 'official' recommendations is what led us to write the review! However, after we gathered and analyzed the available information, we developed these recommendations:
- A thorough assessment of the patient's vaccination status should be done before beginning treatment with a biologic agent.
- Vaccination can be administered during therapy with anti-TNF alpha agents, tocilizumab, and abatacept (Orencia®), but ideally should be given before B cell-depleting agents such as rituximab (Rituxan®).
- Live attenuated vaccines should be avoided, notably in anyone taking more than 10mg daily of any corticosteroid, or taking an immunosuppressive drug such as mycophenolate mofetil (CellCept®), cyclophosphamide, or azathioprine (Imuran®), or taking biologic agents.
- The influenza and pneumococcal vaccines are strongly recommended.
- Tetanus toxoid vaccination should be administered as in the general population, except if the patient has been treated with rituximab within the last 24 weeks and is at high risk of developing tetanus, in which case passive immunization with tetanus immunoglobulin is strongly advised.
Should people with lupus receive vaccinations against human papilloma virus, varicella zoster, hepatitis A and B, BCG (tuberculosis), meningococcus, or Hemophilus influenzae type B?
Regrettably, there are no data at this time to help advise patients taking biologics with respect to the use of these vaccines.