Vaccination before Starting Biologics: Are We Going a Good Job?

New study Suggests We Don’t Vaccinated Enough - Especially our Younger Patients

There is a great deal of information that must be conveyed to patients before starting JAK inhibitors. One of these is a review of infections and ways to reduce the risk of infection through vaccination.

Immunization against zoster, influenza and pneumococcus are generally recommended before starting JAK inhibitors. For example, zoster is recommended at age 19 or above now by the CDC (and 50 years of age and over in the general population). Influenza is recommended yearly. Pneumococcous is now recommended at 19 and over in immunocompromised patients (rather than 65 years in the general population).

Review of other vaccinations such as meningococcus, Haemophilus influenzae type b, Neisseria meningitidis, hepatitis B, diphtheria and tetanus, HPV can also be reviewed.

Hren and Khattri, 2024

A new study reminds us all that we are not getting our patients vaccinated before starging biologics and JAK inhibitors as often as we should be!

Authors from New York reviewed patients  ≥ 19-years-old prescribed a biologic or JAK inhibitor for a range of immune diseases. (including atopic dermatitis, psoriasis, psoriatic arthritis, and alopecia areata) between 10/2003 and 10/2023 at a large tertiary institution.

Overall, vaccination rates among patients on biologics and JAK inhibitors were low, with rates being significantly lower in patients 19-64 years-old, compared to those ≥ 65 years-old for most disease states (p < 0.01).

Among patients with atopic dermatitis, psoriasis, and alopecia areata, on average, 9.39% were vaccinated for influenza, 6.76% for herpes zoster, 16.56% for pneumococcal pneumonia, and 63.98% for COVID-19. Only 3.16% of patients were adequately vaccinated for HepB after an abnormal HepB SA test.

Specific rates for alopecia areata are shown in the chart below:

Comment

This study is a nice reminder that our patients are not being vaccinated as often as they should. There is clearly a very large amount of room for improvement! It’s not always known that patients 19 and over can receive the zoster vaccine and the pneumococcal vaccination series. Drug companies often inquire about the tuberculosis status of patients before starting the drug - but perhaps more emphasis can be given to thoroughly reviewing the vaccination status of patients. There is a lot of talk about before starting JAK inhibitors.

Overall, more training of physicians is needed to ensure that patient safety on JAK inhibitors is maximized.

REFERENCE

Hren MG and Khattri S. Low rates of vaccination among atopic dermatitis, alopecia areata, psoriasis, and psoriatic arthritis patients on biologics. Arch Dermatol Res. 2024 May 25;316(6):285.