Recommendations for Vaccination in Children with Atopic Dermatitis Treated with Dupilumab: A Consensus Meeting, 2020

Abstract

Dupilumab is the only biologic therapy currently approved in Europe and the United States for severe atopic dermatitis in patients 6 years of age or older. Off-label use is rationalized in younger children with severe atopic dermatitis. Decisions about vaccination for children on dupilumab are complex and depend on both the child’s current treatment and the type of vaccination required. To achieve consensus on recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab, a review of the literature and a modified-Delphi process was conducted by a working group of 5 panelists with expertise in dermatology, immunology, infectious diseases and vaccination. Here, we provide seven recommendations for vaccination of pediatric patients with atopic dermatitis treated with or planning to start dupilumab. These recommendations serve to guide physicians’ decisions about vaccination in children with atopic dermatitis treated with dupilumab. Furthermore, we highlight an unmet need for research to determine how significantly dupilumab affects cellular and humoral immune responses to vaccination with live attenuated and inactivated vaccines. Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00607-6.

Biological therapy in atopic diseases

“…Također se preporučuje razmotriti pojedinačnu potrebu svakog pacijenta za navedenim cjepivom. 46 Tralokinumab i lebrikizumab različitim mehanizmima neutraliziraju IL-13, a odobreni su za liječenje atopijskog dermatitisa u odraslih i adolescenata. Kod obaju lijekova primijećena je reakcija na mjestu primjene samog lijeka, kao i konjunktivitis, što se povezuje kao i kod dupilumaba s inhibicijom IL-13.…”

Recent advances in immunomodulators for atopic dermatitis

“…Dupilumab has demonstrated sustained efficacy and a strong safety profile with normal responses to inactivated vaccines, therefore, inactivated vaccines, including seasonal influenza vaccine may be given during dupilumab treatment [35]. However, there is a lack of data for the risks and efficacy of live-attenuated vaccines during dupilumab treatment, so it is recommended to receive live vaccines at least 4 weeks before starting dupilumab and at least 3 months after stopping dupilumab [36]. However, exception may be made depending on risks vs. benefits on a case-to-case basis.…”

Practical guide for the use of immunobiologic agents in allergic diseases - ASBAI

“…Seasonal or periodic vaccines (flu or dTpa) should be administered without restrictions. 71 It is important to note that although mRNA and viral vector vaccines work slightly differently to inactivated vaccines, none of them are live virus vaccines and can therefore be safely administered to patients receiving biological treatment for allergy. Thus, the vaccines currently available for COVID-19 are indicated for concomitant use with the monoclonal antibodies described here, whether they are inactivated virus vaccines (Sinovac/Butantan); mRNA vaccines (Pfizer-BioNTech; and Moderna); or viral vector vaccines (Johnson & Johnson, Oxford-Astra-Zeneca, and Verity Pharmaceuticals-Serum Institute of India).…”