Experts Provide Vaccine Guidance for Children Treated With Dupilumab

Children treated with the biologic dupilumab for severe atopic dermatitis should not receive live attenuated vaccines, including boosters, without careful consideration of risk as well as the involvement of pediatric subspecialists, according to a set of seven recommendation statements recently published in the American Journal of Clinical Dermatology. 

“The expert panel emphasizes that there is insufficient data on the safety and efficacy of live attenuated vaccines in patients on biologics including dupilumab and recognizes the urgent need for further research to determine whether dupilumab affects the immune response against live attenuated vaccines,” the authors wrote, “and how safe these vaccines would be in children on active therapy.”  

The vaccine guidance stemmed from a literature review and modified-Delphi process for consensus by a working group of five experts in dermatology, immunology, infectious diseases, and vaccination. 

According to the published guidance, inactivated vaccines appear safe for children on dupilumab. Consequently, interruption of dupilumab treatment is not necessary for inactivated vaccine administration. Seasonal inactivated influenza vaccination is also recommended. 

However, available data suggests live attenuated vaccines should be avoided in children treated with dupilumab, researchers advised. Considerations of infection risk versus vaccination risk are acceptable on a case-by-case basis.

“If there is a situation where a live attenuated vaccine is needed, such as a measles outbreak in the community and children without protective measles antibody titers who would go to school, the expert panel recommends an individualized assessment weighing the risk of infection in conjunction with a clinical immunologist and an infectious disease specialist,” experts advised. “Parents should be made aware of the risks taken regarding vaccination and the dangers of infection.”

Reference: 

Martinez-Cabriales SA, Kirchhof MG, Constantinescu CM, Murguia-Favela L, Ramien ML. Recommendations for Vaccination in Children with Atopic Dermatitis Treated with Dupilumab: A Consensus Meeting, 2020. Am J Clin Dermatol. 2021;22(4):443-455. doi:10.1007/s40257-021-00607-6