Pediatric Rheumatology Online Journal (Mar 2018)

The safety of live-attenuated vaccines in patients using IL-1 or IL-6 blockade: an international survey

  • Jerold Jeyaratnam,
  • Nienke M. ter Haar,
  • Helen J. Lachmann,
  • Ozgur Kasapcopur,
  • Amanda K. Ombrello,
  • Donato Rigante,
  • Fatma Dedeoglu,
  • Ezgi H. Baris,
  • Sebastiaan J. Vastert,
  • Nico M. Wulffraat,
  • Joost Frenkel

DOI
https://doi.org/10.1186/s12969-018-0235-z
Journal volume & issue
Vol. 16, no. 1
pp. 1 – 6

Abstract

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Abstract Background Withholding live-attenuated vaccines in patients using interleukin (IL)-1 or IL-6 blocking agents is recommended by guidelines for both pediatric and adult rheumatic diseases, since there is a risk of infection in an immune suppressed host. However, this has never been studied. This retrospective, multicenter survey aimed to evaluate the safety of live-attenuated vaccines in patients using IL-1 or IL-6 blockade. Methods We contacted physicians involved in the treatment of autoinflammatory diseases to investigate potential cases. Patients were included if a live-attenuated vaccine had been administered while they were on IL-1 or IL-6 blockade. Results Seventeen patients were included in this survey (7 systemic juvenile idiopathic arthritis (sJIA), 5 cryopyrin associated periodic syndrome (CAPS), 4 mevalonate kinase deficiency (MKD) and 1 familial Mediterranean fever (FMF). Three patients experienced an adverse event, of which two were serious adverse events (a varicella zoster infection after varicella zoster booster vaccination, and a pneumonia after MMR booster). One additional patient had diarrhea after oral polio vaccine. Further, seven patients experienced a flare of their disease, which were generally mild. Eight patients did not experience an adverse event or a flare. Conclusion We have described a case series of seventeen patients who received a live-attenuated vaccine while using IL-1 or IL-6 blocking medication. The findings of this survey are not a reason to adapt the existing guidelines. Prospective trials are needed in order to acquire more evidence about the safety and efficacy before considering adaptation of guidelines.

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