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The safety of live-attenuated vaccines in patients using IL-1 or IL-6 blockade: an international survey.

Authors :
Jeyaratnam J
Ter Haar NM
Lachmann HJ
Kasapcopur O
Ombrello AK
Rigante D
Dedeoglu F
Baris EH
Vastert SJ
Wulffraat NM
Frenkel J
Source :
Pediatric rheumatology online journal [Pediatr Rheumatol Online J] 2018 Mar 21; Vol. 16 (1), pp. 19. Date of Electronic Publication: 2018 Mar 21.
Publication Year :
2018

Abstract

Background: Withholding live-attenuated vaccines in patients using interleukin (IL)-1 or IL-6 blocking agents is recommended by guidelines for both pediatric and adult rheumatic diseases, since there is a risk of infection in an immune suppressed host. However, this has never been studied. This retrospective, multicenter survey aimed to evaluate the safety of live-attenuated vaccines in patients using IL-1 or IL-6 blockade.<br />Methods: We contacted physicians involved in the treatment of autoinflammatory diseases to investigate potential cases. Patients were included if a live-attenuated vaccine had been administered while they were on IL-1 or IL-6 blockade.<br />Results: Seventeen patients were included in this survey (7 systemic juvenile idiopathic arthritis (sJIA), 5 cryopyrin associated periodic syndrome (CAPS), 4 mevalonate kinase deficiency (MKD) and 1 familial Mediterranean fever (FMF). Three patients experienced an adverse event, of which two were serious adverse events (a varicella zoster infection after varicella zoster booster vaccination, and a pneumonia after MMR booster). One additional patient had diarrhea after oral polio vaccine. Further, seven patients experienced a flare of their disease, which were generally mild. Eight patients did not experience an adverse event or a flare.<br />Conclusion: We have described a case series of seventeen patients who received a live-attenuated vaccine while using IL-1 or IL-6 blocking medication. The findings of this survey are not a reason to adapt the existing guidelines. Prospective trials are needed in order to acquire more evidence about the safety and efficacy before considering adaptation of guidelines.

Details

Language :
English
ISSN :
1546-0096
Volume :
16
Issue :
1
Database :
MEDLINE
Journal :
Pediatric rheumatology online journal
Publication Type :
Academic Journal
Accession number :
29562920
Full Text :
https://doi.org/10.1186/s12969-018-0235-z