The Centers for Disease Control and Prevention (CDC) recently released new information on COVID-19 vaccines for moderately to severely immunocompromised people. Since these individuals may be especially vulnerable to COVID-19, due to their increased risk of serious, prolonged illness, the CDC recommends an additional dose of mRNA COVID-19 vaccine after the initial 2 doses.  

In response, the NPF COVID-19 Task Force has updated its guidance statements to provide additional clarity for people living with psoriatic disease: 

• People with psoriatic disease treated with immunosuppressive or immune-modulating therapies that affect the immune system in a manner that may make a patient more susceptible to infection are eligible for a third dose “booster” mRNA COVID-19 vaccine, per CDC recommendations. 
• This booster vaccine should be administered at least 28 days following the two-dose regimen of the same vaccine, and only to patients ages 12 and older (Pfizer-BioNTech vaccine) or in patients ages 18 and older (Moderna vaccine and Pfizer-BioNTech vaccine). The CDC has not issued recommendations for boosters in patients who received the one dose Ad26.COV2.S vaccine manufactured by Johnson & Johnson. 

Although it is not known whether a third booster dose of an mRNA vaccine will result in additional, clinically important benefits for those taking immunosuppressive or immune-modulating treatments for psoriatic disease, the NPF guidance statements outline specific circumstances where people with psoriatic disease may be more likely to benefit, including: 

• People aged 50 or older 
• People taking abatacept, cyclosporine, leflunomide, glucocorticoids (e.g., prednisone), methotrexate, or tofacitinib 
• People who received their second dose of an mRNA vaccine over 6 months ago 
• People with comorbidities known to increase the risk of severe COVID-19, such as being overweight, being a current or former smoker, or having diabetes, cardiovascular disease, chronic lung, liver, or kidney disease 

Patients taking methotrexate with well-controlled psoriatic disease, may, in consultation with their prescriber, consider holding the medication for 2 weeks after receiving a third “booster” mRNA vaccine to potentially improve vaccine response.  

“The COVID-19 vaccines are safe and effective. We urge those not yet vaccinated to get vaccinated as soon as possible. Those already vaccinated have a dramatically reduced risk of developing severe COVID-19 and now have additional options for a booster vaccine that may add additional protection from this disabling and deadly virus,” said Joel M. Gelfand, MD, MSCE, Professor of Dermatology and Epidemiology at the University of Pennsylvania Perelman School of Medicine and Co-Chair of the NPF COVID-19 Task Force.

The Foundation continues to closely monitor the evolving situation, particularly with the emergence of the Delta variant. The Task Force encourages the psoriatic disease community to consult with a health care provider to guide discussions about the use of a third booster and about the use of systemic therapies during the pandemic.