Department of Pediatrics, The University of Tennessee Health Science Center and LeBonheur Children's Hospital, Memphis, Tennessee.
Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Evidence in Allergy Group, McMaster University and The Research Institute of St. Joe's Hamilton, Hamilton, Canada.
Ann Allergy Asthma Immunol. 2024 Sep;133(3):286-294. doi: 10.1016/j.anai.2024.05.014. Epub 2024 Jun 5.
Dupilumab is a monoclonal antibody that targets the interleukin (IL)-4 receptor alpha subunit, thus blocking the effects of IL-4 and IL-13, and has shown efficacy in treating various conditions including asthma, atopic dermatitis, eosinophilic esophagitis, and others. Because of its immune modulatory effects, clinical trials that studied dupilumab did not allow patients to receive live vaccines during the clinical trials because of an abundance of caution, and thus package inserts recommend that patients who are being treated with dupilumab should avoid live vaccines. Because dupilumab is now approved for use in patients from 6 months of age for the treatment of atopic dermatitis, this reported contraindication is now posing a clinical dilemma for patients and clinicians.
To perform a systematic review of literature on the safety and efficacy of vaccinations in patients who are receiving dupilumab and to provide expert guidance on the use of vaccines in patients who are receiving dupilumab.
A systematic review of the literature was performed, and an expert Delphi Panel was assembled.
The available literature on patients who received vaccinations while using dupilumab overall suggests that live vaccines are safe and that the vaccine efficacy, in general, is not affected by dupilumab. The expert Delphi panel agreed that the use of vaccines in patients receiving dupilumab was likely safe and effective.
Vaccines (including live vaccines) can be administered to patients receiving dupilumab in a shared decision-making capacity.
度普利尤单抗是一种针对白细胞介素（IL）-4 受体 α 亚单位的单克隆抗体，可阻断 IL-4 和 IL-13 的作用，已被证明对治疗哮喘、特应性皮炎、嗜酸性食管炎等多种疾病有效。由于其免疫调节作用，研究度普利尤单抗的临床试验出于谨慎考虑不允许患者在临床试验期间接种活疫苗，因此说明书建议正在接受度普利尤单抗治疗的患者应避免接种活疫苗。由于度普利尤单抗现已批准用于 6 个月及以上年龄的特应性皮炎患者，因此目前这种禁忌对患者和临床医生来说是一个临床难题。
对正在接受度普利尤单抗治疗的患者接种疫苗的安全性和有效性进行系统评价，并就正在接受度普利尤单抗治疗的患者接种疫苗提供专家指导。
对文献进行系统评价，并组建专家德尔菲小组。
关于正在接受度普利尤单抗治疗的患者接种疫苗的总体可用文献表明，活疫苗是安全的，并且度普利尤单抗一般不会影响疫苗的疗效。专家德尔菲小组一致认为，正在接受度普利尤单抗治疗的患者接种疫苗可能是安全且有效的。
在共同决策的情况下，可以向正在接受度普利尤单抗治疗的患者接种疫苗（包括活疫苗）。
