A new ACAAI position paper concludes that live vaccines are generally safe for patients on dupilumab but emphasizes the importance of shared decision-making.

RT’s Three Key Takeaways:

  1. The ACAAI recommends doctors and patients being treated with dupilumab should engage in shared decision-making before the administration of live vaccines.
  2.  The systematic review concluded that it is generally safe to continue dupilumab treatment while administering live vaccines, without the need to pause the biologic therapy.
  3. Despite previous concerns about the immunomodulatory effects of dupilumab on live vaccines, the panel found no significant evidence to support these concerns, though larger studies are needed for definitive proof.

A new position paper from the American College of Allergy, Asthma & Immunology (ACAAI) addresses the safety of administering live vaccines to patients who are currently being treated with dupilumab, a biologic therapy for various allergic conditions

The paper is published online in Annals of Allergy, Asthma & Immunology. The panel conducting the systematic review of available data concluded it is not necessary to stop treatment with dupilumab to give live vaccines; however, the decision should be shared between the physician and the patient/parent regarding the risk and benefits of the options.

Review and Expert Consensus

The goal of the review was to determine the best approach so that patients who are finding success and relief with the biologic treatment can also have the full protection of all vaccines recommended by public health agencies and medical specialty organizations. Dupilumab is used to treat a range of allergic conditions in children including asthma, atopic dermatitis, chronic rhinosinusitis and eosinophilic esophagitis.

The systematic review was performed, and relevant clinical questions were answered, utilizing a Delphi panel of top allergy and immunology experts who reviewed the results of the review. The question of co-administration of live vaccines and dupilumab took on increased interest once the biologic was approved for use in children down to 6 months of age. Adults are less likely to need live vaccines. 

Live Vaccines and Dupilumab Usage

Live vaccines currently on the US recommended immunization schedule include: measles, mumps, rubella (MMR); varicella; rotavirus; and the nasal spray version of influenza vaccine.

Since it was approved for use in adults in 2017 and children in 2020, the manufacturer of dupilumab has recommended that live vaccines should not be given concurrently with the biologic. This is because of the possibility that the immunomodulatory effect of dupilumab could blunt or lessen the effectiveness of the live vaccine or increase the chance of infection with the live virus contained in the vaccine. 

However, the Delphi panel concluded that the available data, while limited, do not support that concern. It should be noted that a large, well-designed research study would be needed to demonstrate safety more definitively.

Expert Recommendations for Clinicians

The recommendation of the panel is that doctors and patients/parents should engage in shared decision-making to determine when and if live vaccines should be given to an individual who is being treated with dupilumab, or whether treatment should be paused. A board-certified allergist/immunologist has special training to manage the treatment of adults and children with asthma or allergies who may benefit from this medication.

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