Table IV.

Preliminary guidance for monkeypox (MPX) vaccination timing in patients on immunosuppression or immunomodulation for dermatologic disease^∗†

Agent	Recommendation
TNFi, IL-6R, IL-1R, IL-17, IL12/23, IL-23, and other cytokine inhibitors	No consensus. Use shared decision-making with patients (eg, continue biologic as scheduled with plan for supplemental booster doses when available)
Cyclophosphamide IV	Time CYC to 1 wk after each MPX vaccine dose as allowed
Rituximab (RXT)	Variable timing if based on CD19 B cell measurement. Otherwise, when initiating RTX, administer the first MPX vaccine dose 4 wk before the first RTX cycle and delay the subsequent RTX cycle 2-4 wk after the second MPX vaccine dose. With maintenance RTX, consider a booster dose 2-4 wk before the next RTX dose.
Other immunosuppressants (eg, JAKi, MMF, MTX)	Hold for 1-2 wk as allowed after each MPX vaccine dose
Acetaminophen, NSAIDs	Hold for 24 h prior to vaccine, no restrictions post vaccine
Hydroxychloroquine, dapsone, IVIG	No modifications needed

CYC, Cyclophosphamide; IL, interleukin; IV, intravenous; IVIG, intravenous immunoglobulin; JAKi, janus kinase inhibitor; MMF, mycophenolate mofetil; MPX, monkeypox; NSAID, non-steroidal anti-inflammatory drug; TNFi, tumor necrosis factor inhibitor.

^∗Adapted from Table III in American College of Rheumatology COVID-19 Vaccine Clinical Guidance Summary.

^†JYNNEOS or other replication deficient MPX vaccine.