Vaccination delayed, avoided with dupilumab treatment
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Key takeaways:
- More than 80% of children who did not get their second vaccine doses did not because of dupilumab treatment.
- Those who did get second doses did so later than children not on dupilumab.
WASHINGTON — Children taking dupilumab for atopic diseases received measles, mumps and rubella and varicella immunizations later than other children, according to a poster presented here.
Also, immunization during dupilumab therapy appeared safe despite FDA guidance advising against live vaccines during therapy with the biologic, Hannah Seay, MD, a resident physician at Children’s Hospital of Philadelphia, told Healio.
“Clinical trials fail to include kids who have been treated with live vaccines within 4 weeks of the baseline visit,” Seay said. “It’s really just because it was not studied.”
To see if these recommendations result in delayed vaccinations, Seay and her colleagues conducted a retrospective review, presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting, of 284 patients (54% boys; 38% white) aged 9 years and younger (mean age, 5 years 10 months) who were being treated with dupilumab (Dupixent; Regeneron, Sanofi) and were eligible for measles, mumps and rubella (MMR) and varicella vaccination.
These children included 262 (92%) who were being treated with dupilumab for atopic dermatitis, 16 (6%) who were being treated for asthma and four (1%) who were being treated for eosinophilic esophagitis.
The cohort included 281 children who received the first dose of the MMR vaccine. Although 217 of these children were then eligible for the second dose, 30 did not get it, and 25 of those children did not because they were on dupilumab treatment.
Similarly, 280 received the first dose of the varicella vaccine, with 216 eligible for the second dose. Twenty-six of these children did not get the second dose, including 21 who did not because they were on dupilumab treatment.
“Greater than 80% of patients who didn’t receive MMR and varicella vaccines were attributable to dupilumab,” Seay said.
Also, Seay noted that overall vaccination rates in Pennsylvania include 93.7% for the second varicella dose and 94% for the second MMR dose. But in this cohort, only 88% received the second varicella dose and 86% received the second MMR dose.
Second doses also were significantly delayed among the children who received them, Seay said.
“Overall, we demonstrated that the age of MMR and varicella vaccination tend to be higher among kids on dupilumab,” she said.
Average ages included 4.3 years for those who received the second dose of the varicella vaccine before initiating dupilumab treatment and 4.55 years for those who received it after beginning dupilumab (P = .0233).
Similarly, average ages included 4.29 years for those who received the second dose of the MMR vaccine before dupilumab and 4.55 for those who received the second dose after dupilumab (P = .0286).
Seay further said that additional data indicated that immunization with MMR and varicella vaccines during dupilumab treatment could be safe and that her team is continuing to investigate their safety with dupilumab.
“There’s no mechanistic process that I can think of that would make them unsafe,” she said, adding that she and her colleagues are continuing to study their safety. “We just don’t have the data yet to prove it.”
Seay and her colleagues also are studying the effectiveness of these vaccines during dupilumab treatment.
“We need to prove with immunization titers that it is effective,” she said. “We had about 30 kids who were on dupilumab, and when they got their vaccines, there were no documented cases of measles, mumps, rubella or varicella.”
These findings appear to favor administering vaccines to children on dupilumab without any delay, Seay said. But in addition to the guidelines recommending against this vaccination, challenges remain.
“We’re still in the process of getting enough data to prove to pharmacy and the general population that it is safe to vaccinate with dupilumab,” Seay said.
The COVID-19 pandemic has not helped matters either, she continued.
“It’s becoming a larger issue now too, especially with COVID and all the vaccine hesitancy that we’re seeing,” Seay said. “We’re seeing kids not getting vaccinated, and we really want to make sure that the kids get MMR and varicella vaccines.”
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For more information:
Hannah Seay, MD, can be reached at seayh@chop.edu.