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Table 3 Summary of data for vaccine efficacy and safety with immunomodulatory therapies

From: Effects of biological and non-biological immunomodulatory therapies on the immunogenicity of vaccines in patients with rheumatic diseases

Drug Protein vaccines Carbohydrate vaccines DTH/cellular immunity Neoantigen Live virus
Non-biologic immunomodulators
Corticosteroids --/↓ -- ND ND Zoster OK with CCS <20 mg/day
Methotrexate ↓↓ -- -- Zoster OK with MTX <0.4 mg/kg/week
Anti-malarials -- -- ND ND Probably safe, possible ↓ response
Sulfasalazine --/↓ ND ND ND Probably safe, not formally studied
Leflunomide -- ND ND ND ND
Azathioprine -- --/↓ ND ND Zoster OK <3 mg/kg/day
Mycophenolate ↓↓ ↓↓ Avoid
Calcineurin Inhibitors --/↓ ND ND Avoid
Biologicals and targeted immunomodulators
TNF inhibitors --/↓ --/↓ -- ND Avoid
Abatacept (CTLA4-Ig) ND Avoid
Rituximab (anti-CD20) --/↓ ↓↓ ↓↓ Avoid
Tocilizumab (anti-IL6) -- -- ND ND Avoid
Ustekinumab (anti-IL-12/23) -- -- ND ND Avoid
IL- 1 inhibitors (anakinra, Rilonacept, canakinumab) ND ND ND ND Avoid
Belimumab (anti-BLyS) ND ND ND ND Avoid
Tofacitinib (Jak1/3) --/↓ ND ND Avoid
  1. ↓ decreased, ↓↓ markedly decreased, -- no effect. BLyS, B lymphocyte stimulator; CCS, corticosteroids; DTH, delayed type hypersensitivity; MTX, methotrexate; ND, not determined; TNF, tumor necrosis factor.