Immunosuppressive drugs vs immunogenicity and safety of vaccination
| Medication | Studies (abstract) | Patients (juvenile)/healthy controls | LoE | Immunogenicity (LoE) | Safety (LoE) |
|---|---|---|---|---|---|
| Corticosteroids* | 14 (1) | 1087 (147)/288 | 1B–4 | Good immunogenicity HBV (2A), flu (2A), PPV (2B), VZV (3) on GC <10 mg/day | Composite 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) | ||||
| Methotrexate | 18 (3) | 1758 (230)/226 | 2A–4 | Good immunogenicity HBV (2A), flu (2A), TT (4), MMR (3) with methotrexate <15 mg/m2/week | Composite 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 DMARD | 10 (1) | 627 (49)/231 | 1B–4 | Good 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-TNFα | 23 (4) | 2181 (186)/318 | 1B–4 | Good 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) | ||||
| Rituximab | 6 (1) | 313 (0)/70 | 1B–4 | Good 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-6 | 2 (2) | 98 (31)/19 | 3 | Good immunogenicity flu (3) | Composite vaccines safe in 31 patients (3) |
| Anti-CD11a | 1 (0) | 62 (0)/0 | 1B | Good 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.