Vaccination plays a critical role in protecting against infectious diseases, particularly in those with compromised immune systems. While traditional recommendations advise against live attenuated vaccination in patients undergoing most biologic therapies due to the potential risk of serious infections (vaccine-related disease caused by unchecked replication of the live vaccine microorganism), emerging evidence and expert opinion suggest live attenuated vaccines may be safely and effectively administered with appropriate precautions when using certain medications such as dupilumab and apremilast. This systematic review evaluates the administration of live attenuated vaccines in patients receiving these drugs. A search of MEDLINE and Embase identified 12 relevant publications, including 2 case series, 3 clinical trials, and 7 consensus statements, recommendations, or guidelines. The findings suggest that, in certain circumstances, live attenuated vaccines may be safely administered to patients on dupilumab with appropriate precautions. Data on live attenuated vaccination with apremilast remain limited. Current recommendations emphasise shared decision-making between clinicians and patients, considering individual risk factors. Further evidence is needed to establish definitive guidelines on live attenuated vaccine administration in patients receiving these therapies. Copyright © 2025 Australasian College of Dermatologists.
Abstract
Adults
Safety
Efficacy/effectiveness
