Table 2.

Summary of drug-specific vaccine recommendations for dermatology patients, by therapy.

Drug	Recommended Vaccines	Additional Considerations	Notes
High-dose1 glucocorticoids	Influenza Pneumonia2 Shingrix (≥50 years)	Shingrix in patients <50 years	Consider additional vaccinations for future steroid sparing agents
Methotrexate	Influenza Pneumonia (>65 years) Shingrix (≥50 years)		Additional vaccines may be necessary for combination therapy or those receiving >0.4 mg/kg/week
Cyclosporine, Mycophenolate, & Azathioprine	Influenza Pneumonia2 Shingrix (≥50 years)	HPV prior to MMF	Consider additional vaccinations for CSA patients transitioning to other agents
TNF inhibitors & other biologics	Influenza Pneumonia2 Shingrix (≥50 years)
JAK Inhibitors	Influenza Pneumonia2 Shingrix (≥50 years)	Shingrix in patients <50 years
Rituximab	Influenza Pneumonia2 Shingrix (≥50 years)		Administer vaccines 4 weeks prior to starting or at least 6 months after therapy for the best response

¹High-dose glucocorticoids: ≥20 mg/day of prednisone for ≥2 weeks.

²Pneumonia vaccination strategy in patients who are iatrogenically immunosuppressed: PCV13 followed by a dose of PPSV23 at least 8 weeks later.