What are your vaccine recommendations while patients are on biologics?

Live vaccines are best completed at least a month before initiation of biologics when these are appropriate (e.g., MMR, chickenpox, yellow fever).

The data on non-live vaccines is limited. I personally think that some degree of protection is better than none. I will not interrupt biological therapy for a flu shot, for example, but would recommend getting it annually and believe it provides some degree of protection.

Very complicated situation because even though the easy answer is to get the live vaccine first, can we be sure that the live vaccine won’t worsen the autoimmune disease if we hold or stop the biologic? I’m sure each biologic and vaccine interaction is different as well. There are different parts of T cell immunity that may cause large variations in which antigens on vaccines are at risk and may or may not share similarities with targets of the biologic.
I think once molecular details and these ...