Table 2.
Recommended infection screening and vaccination before immunotherapy
| Drug | FDA and/or EMA requirements | Additional recommendations | |
|---|---|---|---|
| Infection screening | Vaccination | ||
| Alemtuzumab | Annual HPV and Pap smears | Screen for HBV, HCV, HIV, TB, syphilis and VZV; pneumococcal vaccination (regional recommendations); annual influenza vaccination (optional); VZV vaccination if seronegative; avoid attenuated live vaccines (obligatory) | |
| Azathioprine | Live vaccines contraindicated; immune response should be controlled by means of titre determination | Screen for HBV, HCV, HIV, TB and VZV; VZV vaccination if seronegative; pneumococcal vaccination (regional recommendations); annual influenza vaccination (optional); avoid attenuated live vaccines up to 3 months after treatment (obligatory) | |
| Cladribine | Screen for HBV and HCV | VZV if antibody negative | Screen for HBV, HCV, HIV, TB and VZV; VZV vaccination if seronegative; annual influenza vaccination (optional); avoid attenuated live vaccines |
| Cyclophosphamide | Exclude acute infection; screen for HBV, HCV and TB | Live vaccines contraindicated | Screen for HBV, HCV, HIV, TB, syphilis and VZV; consider antimicrobial and antifungal prophylaxis |
| Dimethyl fumarate, diroximel fumarate | Screen for HBV, HCV, HIV and TB (optional); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) | ||
| Eculizumab | Exclude acute infection | Immunizations before initiation according to current guidelines; meningococcal vaccine (serogroups A, C, Y, W-135 and B), consider bridging with antibiotic prophylaxis; Haemophilus influenzae and pneumococcal vaccine (age <18 years) | Screen for HBV, HCV, HIV, TB, syphilis and VZV; pneumococcal (regional recommendations); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) |
| Fingolimod | VZV antibody screening | VZV if antibody negative | Screen for HBV, HCV, HIV and VZV; VZV vaccination if seronegative; HBV and HPV vaccination (optional); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) |
| Glatirameroids | Annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) | ||
| Glucocorticosteroids | Exclude acute infection | Avoid attenuated live vaccines (obligatory) | |
| IFNβ | Annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) | ||
| Inebilizumab | Exclude acute infection; screen for HBV, TB; quantify serum immunoglobulins | Live attenuated or live vaccines not recommended during treatment or until B cell repletion; complete required vaccinations ≥4 weeks before initiation | Check vaccination status before initiation; screen for HBV, HCV, HIV, TB and VZV; seasonal influenza vaccination (optional); avoid attenuated live vaccines (obligatory); test for quantitative serum immunoglobulins |
| Mitoxantrone | Exclude acute infection | Live vaccines contraindicated; delay vaccination for 3 months after treatment | Screen for HBV, HCV, HIV and TB (optional); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) |
| Mycophenolate mofetil | Live vaccines contraindicated | Screen for HBV, HCV, HIV, TB and VZV; VZV vaccination if seronegative; pneumococcal vaccination (regional recommendations); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory); screen for hypogammaglobulinaemia during treatment | |
| Natalizumab | Screen for HBV, HCV, HIV, JCV, TB and VZV (optional); VZV vaccination if seronegative; annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) | ||
| Ocrelizumab | Screen for HBV and HCV | Check vaccination status before initiation; screen for HBV, HCV, HIV, TB and VZV; pneumococcal vaccination (regional recommendations); VZV vaccination if seronegative; HBV vaccination (optional); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) | |
| Ofatumumab | Screen for HBV; quantify serum immunoglobulins | Live attenuated or live vaccines not recommended during treatment or until B cell repletion; complete required vaccinations ≥4 weeks before initiation | Check vaccination status before initiation; screen for HBV, HCV, HIV, TB and VZV; pneumococcal vaccination (regional recommendations); VZV vaccination if seronegative; HBV vaccination (optional); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) |
| Ozanimod | VZV antibody screening | VZV if antibody negative | Screen for HBV, HCV, HIV and VZV; VZV vaccination if seronegative; HBV and HPV vaccination (optional); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) |
| Ponesimod | VZV antibody screening | VZV if antibody negative | Screen for HBV, HCV, HIV and VZV; VZV vaccination if seronegative; HBV and HPV vaccination (optional); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) |
| Rituximab | Screen for HBV, HCV, HIV, TB, syphilis and VZV; VZV vaccination if seronegative; pneumococcal vaccination (regional recommendations); HBV vaccination (optional); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) | ||
| Satralizumab | Exclude acute infection; screen for HBV and TB | Immunizations before initiation according to current guidelines | Screen for HBV, HCV, HIV, TB, syphilis and VZV; pneumococcal (regional recommendations); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) |
| Siponimod | Contraindicated history of PML or cryptococcal meningitis; screen for VZV | VZV if antibody negative; delay treatment initiation until 4 weeks after vaccination | Screen for HBV, HCV, HIV and VZV; VZV vaccination if seronegative; annual influenza vaccination (optional); avoid attenuated live vaccines up to 4 weeks after treatment (obligatory) |
| Teriflunomide | Screen for HBV, HCV, HIV and TB (optional); annual influenza vaccination (optional); avoid attenuated live vaccines | ||
| Tocilizumab | Exclude acute infection; screen for HBV and TB | Immunizations before initiation according to current guidelines | Screen for HBV, HCV, HIV, TB, syphilis and VZV; pneumococcal vaccine vaccination (regional recommendations); annual influenza vaccination (optional); avoid attenuated live vaccines (obligatory) |