People with psoriasis and psoriatic arthritis should talk with their doctors about vaccinations before starting on biologic drugs or other treatments that suppress the immune system, according to recommendations from the National Psoriasis Foundation (NPF) Medical Board. Additionally, people should only take inactivated vaccines while on immunosuppressive drugs, the report notes. Read the full report at: www.psoriasis.org/vaccines.
The NPF Medical Board paper, published in the Journal of the American Academy of Dermatology, states that keeping up to date with routine vaccinations would protect people with psoriasis and psoriatic arthritis whose immune systems are compromised from biologic drugs. However, the report notes that many adults with psoriasis are behind on vaccinations. Although inactive vaccines are safe, they may not be as effective for people on biologics, the report finds.
Additionally, vaccination itself may pose a risk to an individual currently taking biologics. Biologic drugs treat psoriasis - the most common autoimmune disease in the country, affecting up to 7.5 million Americans - and psoriatic arthritis - an inflammatory arthritis affecting up to 30 percent of psoriasis patients - by blocking some of the immune system processes that create inflammation. While biologics often improve the disease, they also interfere with parts of the immune system that fight off infection.
"Physicians treating people with psoriasis and psoriatic arthritis should advise their patients carefully about vaccines before starting on biologics or other immunosuppressive treatments," said Dr. Abby Van Voorhees, NPF Medical Board member and co-author of the report. "More careful study is needed on the safety and effectiveness of specific vaccines in people with compromised immune systems."
Following are the routine vaccination recommendations:
| Vaccine | Before systemic therapy | On systemic therapy |
| Flu | Vaccinate with either live or inactivated vaccine | Vaccinate yearly with inactivated vaccine |
| Chicken pox | Test for immunity; if negative, offer vaccine | Not recommended in most cases. Discuss with physician |
| Zoster (Shingles) | 1 dose for adults under 50 | Not recommended, but limited data from 1 study suggests it may be feasible |
| HPV | Recommended for males and females up to age 26 | Recommended for males and females up to age 26 |
| Hepatitis A | Vaccinate if at high risk | Vaccinate if at high risk, consider verifying immunization afterward |
| Hepatitis B | Vaccinate if tests show no disease or immunity and if risk factors are present | Use high-dose vaccine, consider verifying immunization afterward |
| Pneumococcal | Recommended, but precede with PPSV23 vaccination | Vaccinate first with PCV13, then PPSV23 |
| Hib | Vaccinate unvaccinated adults | Vaccinate unvaccinated adults |
| Measles-mumps-rubella | Vaccinate if no history of disease and tests show no immunity | Not recommended in most cases. Discuss with physician |
| Tetanus-diptheria-pertussis | If wounds are high-risk and patient has had no pertussis vaccination, vaccinate with Tdap, provided last Td vaccination was more than two years prior. Booster dose if more than 10 years prior | If wounds are high-risk and patient has had no pertussis vaccination, vaccinate with Tdap, provided last Td vaccination was more than two years prior. Booster dose if more than 10 years prior |
| Meningococcal (Meningitis) | Vaccinate if at high risk | Vaccinate if at high risk |
| Polio | Vaccinate if at high risk | Vaccinate if at high risk |