COVID-19 Vaccine and Biologics: An Impending Dilemma

Abstract

3. A small subset of patients who prioritize high titer immunity over potential skin flare may consider biologic discontinuation prior to receiving an inactive vaccine. We believe that regions with high rates of COVID-19 infection, hospitalization, or mortality may justify this unique approach. Detailed guidance will be required in order to safely vaccinate biologic-maintained patients. When faced with the possibility of interrupting immunosuppressive treatments dermatologists may fear the development of antidrug antibodies (ADAs) that diminish the efficacy of biologic therapy. Recent studies of newer biologics, those targeting the IL-23/IL-17 immunological pathways such as guselkumab, tildrakizumab, and ustekinumab, reveal less than 6.7% of patients developing ADAs. 5 The lower occurrence of immunogenicity seen with IL-23/IL-17 biologics and the growing arsenal of available treatments make restarting or switching biologic therapy after a pause for vaccination a more plausible therapeutic option. We believe early anticipation of vaccine scenarios is essential to ensure safe management of patients on biologic therapies throughout all phases of the COVID-19 pandemic. DISCLOSURES Dr. Krase has done consulting for AbbVie and has received an honorarium. Ms. Hauptman and Dr. Vasic have no potential perceived conflicts of interest to disclose.

A systematic review on mucocutaneous presentations after COVID‐19 vaccination and expert recommendations about vaccination of important immune‐mediated dermatologic disorders

“…These points have been categorized in the table as depicted below: For patients with autoimmune disorders Autoimmune inflammatory rheumatic diseases 82 , 83 , 84 , 85 , 86 , 87 Psoriasis 88 , 89 Hidradenitis suppurativa 90 Patients with pemphigus on rituximab 91 Inflammatory bowel diseases 92 For patients with allergic or atopic disorders Atopic dermatitis 93 , 94 , 95 Mastocytosis 96 , 97 Urticaria 93 , 94 Allergic diseases (general) 98 , 99 , 100 , 101 , 102 , 103 Precautions for anaphylaxis 104 , 105 , 106 , 107 , 108 For dermatology patients on Immunosuppressive, immunomodulatory or biologic therapies 109 , 110 , 111 , 112 , 113 Precautions for vaccine‐induced thrombotic thrombocytopenia 72 , 114 …”

“…For dermatology patients on Immunosuppressive, immunomodulatory or biologic therapies 109 , 110 , 111 , 112 , 113 …”

“…2.3 Urticaria 93,94 2.4 Allergic diseases (general) [98][99][100][101][102][103] 2.5 Precautions for anaphylaxis [104][105][106][107][108] 3. For dermatology patients on Immunosuppressive, immunomodulatory or biologic therapies [109][110][111][112][113] 4. Precautions for vaccine-induced thrombotic thrombocytopenia 72,114 5.…”