TOPLINE:

In a retrospective review of 184 children with atopic dermatitis (AD) treated with dupilumab, four of the 19 who received live-attenuated vaccines experienced adverse events, including one hospitalization; altering dupilumab dose had no significant impact on the adverse event rate.

METHODOLOGY:

• Researchers conducted a retrospective chart review at Children’s Wisconsin, including 184 patients aged 6 months to 10 years (median 6 years; 41% girls; 56% White, 34% Black, and 15% Hispanic or Latino individuals) receiving dupilumab for AD between January 2014 and June 2024.
• Researchers analyzed dupilumab dosing, vaccination information, and adverse events.
• Overall, 19 (10%) patients received live vaccines; of these, 15 received measles, mumps, rubella, and varicella combined vaccine (booster); two received measles, mumps, and rubella vaccine plus separate varicella vaccine (primary series); and two received varicella vaccine only (primary series).

TAKEAWAY:

• Among vaccine recipients, four children experienced adverse events: One had a serious adverse event — hospitalization for dehydration (which the authors said was not likely related to vaccination), and three had mild and self-limited adverse events. Mild events were fever, vomiting, upper respiratory infection symptoms, and injection-site reactions.
• Among vaccine recipients, nine altered their dupilumab schedule to receive live vaccines, the median delay from most recent dupilumab injection to vaccination was 4 weeks for patients who altered their schedule; altering the schedule had no significant impact on the occurrence of adverse events (P = .364).
• Of the children with adverse events, three received booster doses and one received a primary series dose.

IN PRACTICE:

“Our findings are in line with recent consensus guidelines suggesting minimal risk,” the study authors wrote, noting that while the FDA recommends against vaccinations during dupilumab treatment, the guidelines “support shared decision-making, citing no safety concerns in published data.” Larger prospective studies, they added, “are necessary to confirm safety and assess immune response to live vaccines during dupilumab therapy.”

SOURCE:

The study was led by Grace Eleanor Sessler Bruess, Department of Dermatology, Medical College of Wisconsin, Milwaukee, and was published online on September 2 in Pediatric Dermatology.

LIMITATIONS:

The study limitations included the single center, retrospective design; small sample size; lack of postvaccination antibody titers; and potential underreporting of mild adverse events that did not require medical attention.

DISCLOSURES:

The authors did not report any funding information. Bruess reported receiving support from the Wisconsin Medical Society Foundation Medical Student Summer Fellowship Award. Another reported being an author and reviewer for UpToDate.com and a speaker for Krystal Biotech. All other authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.