All clinician resources
Monitoring & safety
Vaccines in Immunosuppressed Patients
Practical vaccine guidance for patients on DMARDs and biologics.
Video lesson
Key points
Inactivated vaccines are safe for all: influenza yearly, pneumococcal (PCV20 or PCV21), COVID-19, recombinant zoster (Shingrix) for adults 19 and older on immunosuppression, hepatitis B and HPV as indicated.
Practical approach
Live vaccines (MMR, varicella, yellow fever) are generally avoided on biologics, JAK inhibitors and higher-dose immunosuppression. For methotrexate, holding 2 weeks after flu vaccination may improve response. Vaccinate at least 2 weeks before rituximab when possible.
Pearls
Response to vaccines is blunted most by rituximab, mycophenolate and high-dose steroids.
At a glance
Category
Monitoring & safety
Reviewed by Farhan Tahir, MD, FACR
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For education only. Don’t start, stop or change a medicine without talking to your care team.