Case Series Finds No Serious Adverse Events as a Result of Live Attenuated Vaccines in Children Treated With Dupilumab

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In a study of pediatric patients with atopic dermatitis (AD) being treated with dupilumab, investigators found that administration of live attenuated MMR vaccination, regardless of the addition of a live attenuated varicella vaccination, did not lead to any serious adverse events (SAE) in the immediate 4 weeks following vaccine administration.

The research was presented in a poster¹ at the 2023 Society of Dermatology Physician Assistants Fall Conference in Nashville, TN.

Study authors Siegried et al sought to explore the clinical course of pediatric patients with AD being treated with dupilumab who also received a live attenuated vaccination during the LIBERTY AD PRESCHOOL (NCT03346434, part B) and LIBERTY AD PED-OLE (OLE; NCT02612454) studies.

In particular, investigators examined 9 individual patient cases of study participants with severe AD as measured by an Investigator’s Global Assessment score of 4. These participants had received a live attenuated vaccination during either of the studies, with 1 patient receiving a vaccine during the LIBERTY AD PRESCHOOL study and 8 receiving a vaccination during LIBERTY AD PED-OLE.

In the case of the patient receiving a live attenuated vaccine during LIBERTY AD PRESCHOOL, a gap of 12 or fewer weeks was added between live attenuated vaccine and dupilumab administration. In LIBERTY AD PED-OLE, 4 patients in this case series had the same gap of time between vaccination and dupilumab administration, while 4 patients received a vaccination and dupilumab greater than 12 weeks apart.

The most common live attenuated vaccinations administered to this group of patients included the MMR, varicella, and DTaP vaccines.

In total, no adverse events (AE), SAEs, or treatment-emergent infections and infestations (TEII) were reported among these patients within 4 or fewer weeks after live vaccination administration.

Greater than 4 weeks after vaccination, no AEs or SAEs were reported in any of the case series patients. However, some TEII were reported in 4 of the 8 patients included in the case series. These included nasopharyngitis, COVID-19, croup infectious molluscum contagiosum, and hand, foot, and mouth disease.

“In this limited retrospective case series of children with severe AD who also received the live attenuated MMR vaccine, with or without live attenuated varicella vaccine, no vaccine related viral infections or SAEs were observed either in the immediate 4-week period following vaccination or beyond 4 weeks post-vaccination,” wrote Siegfried et al. “Additional research is needed to assess the safety of live attenuated vaccines in patients on dupilumab treatment, and to investigate whether dupilumab treatment impacts vaccine efficacy.”

Reference

1. Siegfried EC, Wine Lee L, Spergel JM, et al. A case series on live attenuated vaccine administration in dupilumab-treated children with atopic dermatitis. Poster presented at the 2023 Society of Dermatology Physician Assistants Fall Conference, October 26-29; Nashville, TN.

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