Table 1

Immunosuppressive drugs vs immunogenicity and safety of vaccination

MedicationStudies (abstract)Patients (juvenile)/healthy controlsLoEImmunogenicity (LoE)Safety (LoE)
Corticosteroids*14 (1)1087 (147)/2881B–4Good immunogenicity HBV (2A), flu (2A), PPV (2B), VZV (3) on GC <10 mg/dayComposite vaccines safe in 287 patients (1B)
Lower response to flu on GC >10 mg/day (3), trend to lower response to VZV on GC <10 mg/day (+ other immunosuppressive drugs) (3)Live vaccines (VZV, MMR booster, YFV booster) safe in 35 patients on GC <10 mg/day (3)
Methotrexate18 (3)1758 (230)/2262A–4Good immunogenicity HBV (2A), flu (2A), TT (4), MMR (3) with methotrexate <15 mg/m2/weekComposite vaccines safe in 200 patients (2A)
Lower response to PPV23 on methotrexate 13–25 mg/week (2A), trend to lower response to VZV on methotrexate 12–25 mg/m2/week (3)Live vaccines (VZV, MMR booster, YFV booster) safe in 135 patients on methotrexate <15 mg/m2/week (3)
Other DMARD10 (1)627 (49)/2311B–4Good immunogenicity PPV on AZA and CFM (3)Composite vaccines safe in 210 patients (1B)
Lower response to flu on AZA, CFM and HCQ (2A)YFV booster safe in 44 patients (4)
Anti-TNFα23 (4)2181 (186)/3181B–4Good immunogenicity flu (2A), PPV23 (1B), PCV (2B), MMR (3), TT (4)Composite vaccines safe in 414 patients (2A)
Lower response to PPV23 (2A), PCV7 (4), HBV (3), trend to lower response to YFV (3)Live booster (MMR, YFV) vaccines safe in 28 patients (3)
Rituximab6 (1)313 (0)/701B–4Good immunogenicity TT 6 months after rituximab (1B)Composite vaccines safe in 133 patients (1B)
Lower response to flu (2A), PPV23 (1B)YFV booster vaccine safe in 3 patients (4)
Anti-IL-62 (2)98 (31)/193Good immunogenicity flu (3)Composite vaccines safe in 31 patients (3)
Anti-CD11a1 (0)62 (0)/01BGood immunogenicity PPV23 compared to placebo in 62 psoriasis patients (1B)NA
Lower TT-specific antibodies, but similar protection rate in 62 psoriasis patients (1B)
  • * Only three papers studied paediatric patients, in these studies the maximum GC dose was 10 mg/day or dosages below 0.5–2 mg/kg per day.

  • AZA, azathioprine; CFM, cyclophosphamide; DMARD, disease-modifying antirheumatic drugs; GC, glucocorticosteroids; HBV, hepatitis B virus vaccine; HCQ, hydroxychloroquine; LoE, level of evidence; MMR, measles, mumps, rubella vaccine; NA, not applicable; PCV7, 7-valent pneumococcal conjugate vaccine; PPV23, 23-valent pneumococcal polysaccharide vaccine; TNF, tumour necrosis factor; TT, tetanus toxoid vaccine; YFV, yellow fever vaccine.