. 2021 Jan 19;84(6):1652–1666. doi: 10.1016/j.jaad.2021.01.047

Table III.

Review of data on vaccines and biologics^∗^,^†

Drug	Type of vaccination	Adverse events	Effects on immunity	Level of evidence
Adalimumab (TNF inhibitor)	PPSV23¹¹⁷ Influenza¹¹⁷^,¹⁵⁶ HBV¹¹⁴^,¹³³	Safe, generally well tolerated	Variable; some studies show no significant effect on humoral response,¹¹⁷^,¹³³ while others show reduced humoral response.¹¹⁴^,¹¹⁷^,¹⁵⁶	A-B
Certolizumab (TNF inhibitor)¹²¹	Influenza PPSV23	Safe, generally well tolerated	No significant effect on humoral response	A
Etanercept (TNF inhibitor)	MMR⁷⁴ PPSV23⁹⁶^,¹²⁵ PCV13¹³⁴ Influenza¹⁰⁶ HBV¹¹⁴^,¹³⁶	Safe, generally well tolerated No increase in disease activity	Variable; most studies showed no significant effect on humoral response,⁹⁶^,¹²⁵^,¹³⁴ while some showed reduced humoral response.⁷³^,¹⁰⁶^,¹¹⁴	A-B
Infliximab (TNF inhibitor)	Influenza⁷⁶^,¹⁰⁵^,¹⁰⁹^,¹¹³^,¹²⁴ HBV⁹⁷^,¹¹⁴^,¹³³^,¹³⁶ Yellow fever¹²⁹^,¹³⁹ PPSV23¹¹⁰^,¹⁴³	Safe, generally well tolerated No increase in disease activity	Variable efficacy for trivalent influenza and PPSV23 vaccination. Some studies show no significant effect on humoral response,⁷⁶^,¹⁰⁹^,¹²⁴ while others show reduced humoral response.¹⁰⁵^,¹¹⁰^,¹¹³^,¹²⁴ Most studies showed reduced humoral response to HBV vaccination.⁹⁷^,¹¹⁴^,¹³³ Adequate humoral response to yellow fever vaccination.	A-B C^∗
TNF inhibitors grouped	HBV¹⁰⁰^,¹³³^,¹³⁸ HAV⁹⁹^,¹⁰³^,¹³¹ HZ¹⁴⁵ PPSV23¹⁰³^,¹²⁰^,¹²³^,¹³⁸ PCV13¹¹⁵^,¹¹⁸^,¹²⁶^,¹²⁸^,¹⁴⁷ Tdap¹⁰²^,¹⁰⁷ Influenza⁷⁹^,⁸⁰^,¹¹⁵^,¹¹⁶^,¹²²^,¹³⁷^,¹⁴⁰^,¹⁵⁴ Pandemic (A/H1N1)⁷⁷^,⁸³^,¹⁰³	Safe, well tolerated No increase in disease activity	Variable; some studies show no significant effect on humoral response, while others show reduced humoral response. Vaccine possibly associated with lower HZ incidence 2 years after vaccination.¹⁴⁵ No significant difference in humoral response to PPSV23 vaccine between infliximab or etanercept treated patients.¹³⁸	A-B
Ustekinumab (IL-12/23 inhibitor)	Influenza¹⁵⁶ PPSV23¹⁵⁵ Tetanus toxoid¹⁵⁵ HBV¹¹⁴	N/A	Nonimpaired immune response and efficacy of inactivated influenza vaccine. No significant effect on humoral response to PPSV23 and tetanus vaccination. Possible reduced humoral response to HBV vaccination	A-B
Ixekizumab (IL-17 inhibitor)	PPSV23¹⁴⁸ Tetanus toxoid¹⁴⁸	Well tolerated	No significant effect to humoral response	A
Secukinumab (IL-17 inhibitor)	Meningococcal C Conjugate¹⁴⁹ Trivalent influenza¹³⁶^,¹⁴⁹^,¹⁵⁰	Well tolerated No increase in disease activity	No significant effect to humoral response	A-B
Rituximab (anti–CD-20)	Influenza⁹⁸^,¹⁰⁴^,¹⁰⁸^,¹¹¹^,¹¹⁵^,¹¹⁶^,¹²²^,¹³⁰^,¹³⁵^,¹⁴²^,¹⁴⁴ PPSV23¹⁰¹^,¹¹⁵^,¹³⁵ PCV13¹¹²^,126, 127, 128 PCV7¹⁵⁷ TdaP¹⁰² Yellow fever¹²⁹ HBV¹³⁶ HZ¹⁴⁵	Well tolerated No increase in disease activity	The majority of studies found a reduced humoral response to influenza, pneumococcal, HBV, and TdaP vaccine. Vaccination possibly associated with significantly lower HZ incidence 2 years after vaccination.¹⁴⁵ No significant effect on humoral response to yellow fever vaccination.	A-B C^∗
Dupilumab (IL-4/13 inhibitor)	TdaP MPSV4¹⁵³	Safe, well tolerated	No significant effect on humoral response	A
IVIG	MMR¹⁵¹ Influenza¹⁵²	N/A	No significant effect on humoral response when vaccination occurs before IVIG administration. Decreased humoral response when vaccination occurs after IVIG administration.	B

HAV, Hepatitis A vaccine; HBV, hepatitis B virus; HZ, herpes zoster; IL, interleukin; IVIG, intravenous immunoglobulin; MMR, measles, mumps, rubella; MPSV, meningococcal polysaccharide vaccine; N/A, not applicable; PCV, pneumococcal conjugate vaccine; PPSV, pneumococcal polysaccharide vaccine; TdaP, tetanus/diphtheria/pertussis; TNF, tumor necrosis factor.

^∗

The only study with level of evidence C is Oliveira et al.¹²⁹

^†

There were no studies identified evaluating vaccine safety and/or efficacy with following biologics: brodalumab (IL-17 inhibitor), guselkumab (IL-23 inhibitor), risankizumab (IL-23 inhibitor), tildrakizumab (IL-23 inhibitor), anakinra (IL-1 inhibitor), omalizumab.