Review: No Safety Concerns for Live Vaccines with Dupilumab

Live vaccines are likely safe and effective for patients undergoing dupilumab treatment, according to results from a systematic review and expert consensus.

Authors for a new systematic review, combined with expert input from a Delphi panel, provided insights into the safety and efficacy of administering live vaccines to patients receiving dupilumab. Commonly used in the treatment of atopic dermatitis and asthma, dupilumab has traditionally come with a caution against the concurrent use of live vaccines due to theoretical safety concerns. The final analysis, following an extensive literature review, included data on a total of 46 patients who received live vaccines while on dupilumab. The study further reviewed short-term data from 414 patients who had non-live vaccinations, including the mRNA COVID-19 vaccine. 

There were no instances of disseminated infection, and vaccine efficacy appeared to be uncompromised. The Delphi panel, comprised of disease-state experts, reached strong consensus, with over 89% agreement on the safety of administering live vaccines to patients on dupilumab within a shared decision-making framework, noting the absence of substantial evidence or theoretical basis suggesting danger. The panel acknowledged the limited quantity and quality of the available data as a limitation. No significant safety issues were reported.

"Although the number of studies and patients studied are sparse, the risk for patient harm is based on an unsubstantiated theoretical concern that lacks scientific evidence that dupilumab may cause immune suppression that would either hinder titer response, decrease vaccine efficacy, or predispose the recipient to infection with a live vaccine component," the authors wrote. "However, there was very strong consensus among disease-state experts in supporting that this process would be safe, allow for durable immune response to be mounted, and that it would be appropriate to recommend live vaccination in such patients after the vaccinating clinician and patient engaged in a shared decision-making process."

Source:  Lieberman J, et al. Annals of Allergy, Asthma, and Immunology. 2024. Doi:10.1016/j.anai.2024.05.014