Biologic and small-molecule therapies are increasingly used in dermatology for conditions such as psoriasis and atopic dermatitis. Live and live-attenuated vaccines are traditionally avoided in patients receiving these agents due to concerns regarding vaccine-strain infection. We conducted a systematic review to evaluate the safety of live and live-attenuated vaccines in patients receiving biologic or small-molecule therapies used in dermatologic practice. PubMed, Embase (Ovid) and the Cochrane Library were searched from January 2010 to February 2025 for human studies reporting safety or immunogenicity outcomes following live vaccine administration in patients receiving relevant therapies. Of 1104 records identified, nine studies met inclusion criteria, comprising one randomised controlled trial, three cohort studies, three retrospective case series, one cross-sectional observational study and one case report. Vaccines evaluated included measles-mumps-rubella, measles-mumps-rubella-varicella, varicella, live zoster and yellow fever vaccines. Across studies, no cases of vaccine-strain infection or disseminated vaccine-related disease were reported. Mild and self-limiting post-vaccination reactions were described in several cohorts. Where assessed, immunogenicity responses were generally preserved, although data were limited and inconsistently reported. Most included studies involved patients receiving biologic or small-molecule monotherapy, though some cohorts permitted background conventional immunomodulatory therapy. The available evidence, although limited and predominantly observational, suggests that selected live and live-attenuated vaccines may be administered without serious adverse outcomes in carefully chosen patients receiving biologic or small-molecule therapies. Larger prospective studies are needed to better define safety and immunogenicity across newer targeted agents.
Majri et al. (Tue,) studied this question.