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Dermbits

MD, MPH

How would you address live vaccines in pediatric patients on Ixekizumab?

Psoriasis

When we think about our pediatric patients that you want to put on ixicizumab, for example, and the issue of live vaccinations, it's important to know that the key live vaccine that we're really thinking about is the MMR vaccine or the measles mumserubella vaccine. And in these children, it's also good to know that typically the children get two doses of the MMR vaccine, the first one typically at twelve to 15 months of age, and the second one typically between four to six years of age. And I shall also say that eustachinumab is also approved for children six years and older. And etannercept is the one that is approved for children four years and older for moderate to severe plaque psoriasis. So for the second dose, children can receive the second dose earlier, as long as it's at least 28 days after the first dose, according to the CDC recommendations. So with that being said, there's very little data currently in this topic, and we definitely need more research here. But if you have a child who haven't had MMR vaccine, I would probably just have that child get their second dose of MMR vaccine prior to starting the biologic. And let's say you have already started the biologic, and then you realize, oh, they haven't gotten their second dose of MMR vaccine. Then here, the recommendation by some experts is to really hold the biologic for two to three half lives, give the live vaccine, and then wait another two to four weeks. Depends on the viremia level of the live vaccine. So, for example, let's say you start ixychizumab already on the child, and then you realize the child hasn't gotten their second dose of the MMR vaccine and that they need to get that. In this case, I would then hold the ixicizumab injection for 30 days. So that's about two half lifetimes because ixicizumab's half lifetime is about 13 days. So you would hold ixy for 30 days and then give the MMR vaccine, and then you wait another 30 days. In this case, the reason for that waiting period is because the viremia level for some of the mumps component can last up to four weeks. So you wait four weeks after the child receives the MMR vaccine before you resume the next shot of execution. Map for the child and.

How would you address live vaccines in pediatric patients on Ixekizumab?

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