MMR and varicella immunization during dupilumab therapy

The US Food and Drug Administration recommends deferring administration of live vaccines during dupilumab treatment owing to lack of data on safety and efficacy. Understanding the safety profile of measles, mumps, and rubella (MMR) and varicella administration in children taking dupilumab is important to promote appropriate vaccination.

Our aim was to determine the safety of MMR and varicella immunizations during treatment with dupilumab and the impact of dupilumab on MMR and varicella vaccination rates in early childhood.

We performed a single-center retrospective review of children younger than 9 years who were taking dupilumab and had available vaccination records. The primary outcome measures were vaccine-associated infections, vaccine-associated adverse events, and rate of immunization.

Of the 19 patients who received MMR and varicella immunization while taking dupilumab, none experienced severe vaccine-associated events or vaccine-associated infections. One patient reported fever and injection site reaction, and 5 reported a flare of atopic dermatitis (AD). In all, administration of 21 varicella boosters (9.7%) and 25 MMR boosters (11.5%) were delayed because the children were taking dupilumab. There was a significant delay in the age of administration of MMR boosters and varicella boosters when before- and after-dupilumab therapy rates were compared.

MMR and varicella immunization may be safe to administer to children undergoing dupilumab therapy. Pausing dupilumab therapy for administration of live vaccines may lead to flare of underlying AD. Further, dupilumab treatment in early childhood may result in decreased and/or delayed vaccination rates for MMR and varicella. Our findings support the recent recommendation that immunizations not be delayed while patients are receiving dupilumab.