Vaccines and Systemic Therapies
Brownstone-Lebwohl
Quick Reference Chart
This table is not intended to replace medical judgment.
Drug (Clinical Consideration) | Non-Live Vaccine (Possible concern for blunted immune response to vaccine) | Live Vaccine (Possible concern for virus reactivation and infection from vaccine) |
|---|---|---|
| Systemic Therapy | ||
Methotrexate | Consider delaying dose for 2 weeks after vaccination | Consider discontinuing for 2-4 weeks prior and hold for 2-4 weeks after vaccine |
Cyclosporine | No change | Defer next cyclosporine dose until 2-4 weeks after vaccine |
Acitretin | No change | No change |
Apremilast | No change | No change |
TNF-α blocker | No change | Discontinue for 2-3 half lives prior to vaccine, defer next dose until 2-4 weeks after vaccine |
IL-12/23 antagonist | No change | Discontinue for 2-3 half lives prior to vaccine, defer next dose until 2-4 weeks after vaccine |
IL-17 antagonist | No change | Discontinue for 2-3 half lives prior to vaccine, defer next dose until 2-4 weeks after vaccine |
IL-23 antagonist | No change | Discontinue for 2-3 half lives prior to vaccine, defer next dose until 2-4 weeks after vaccine |
JAK Inhibitor (not including TYK2 inhibitors) | No change | Hold for 1 week prior to vaccine, defer next dose until 2-4 weeks after vaccine |
Deucravacitinib | No change | Discontinue for 1 day (2-3 half lives) prior to vaccine, defer next dose until 2-4 weeks after vaccine |
| Vaccine | ||
Common examples | COVID-19, Haemophilus influenzae type b (Hib), hep B, injectable influenza, pneumococcal (PCV13, PPSV23, PCV 10, PCV15), recombinant herpes zoster (Shingrix), tetanus toxoid (diphtheria-tetanus-pertussis, tetanus-diphtheria toxoid) | BCG, intranasal influenza, live zoster (Zostavax), MMR, yellow fever, smallpox, mpox |
BCG=Bacillus Calmette–Guérin vaccine
Reference: Chat VS, Ellebrecht CT, Kingston P, et al. Vaccination recommendations for adults receiving biologics and oral therapies for psoriasis and psoriatic arthritis: Delphi consensus from the medical board of the National Psoriasis Foundation. J Am Acad Dermatol. 2024;90(6):1170-1181. doi:10.1016/j.jaad.2023.12.070
DISCLAIMER: Vaccinations and systemic medications including biologics/JAK inhibitors have not been extensively studied, and the current recommendations are largely based on expert consensus and limited objective data. This chart is for reference only and is not to be substituted for clinical judgment. Please refer to specific package inserts for further information. For many of the agents listed here, as per the package insert, live vaccines should be avoided immediately prior to, during, and immediately after use. The authors are not responsible for treatment decisions or outcomes based on the information in this chart.
v3 - April 7, 2025 – Copyright 2025 Mark Lebwohl, MD, and Nicholas Brownstone, MD.