What are the recommendations for pneumococcal vaccine administration in patients taking Skyrizi (Risankizumab)?

Pneumococcal Vaccination for Patients on Skyrizi (Risankizumab)

Patients taking Skyrizi (risankizumab) should receive pneumococcal vaccination according to the standard recommendations for immunocompromised individuals, which includes either a single dose of PCV20 or a sequential regimen of PCV15 followed by PPSV23. 1, 2

Vaccination Recommendations

Primary Vaccination Strategy

For patients on Skyrizi who have not previously received pneumococcal vaccines:

• Preferred option: Single dose of 20-valent pneumococcal conjugate vaccine (PCV20)
• Alternative option: 15-valent pneumococcal conjugate vaccine (PCV15) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 8 weeks later

Timing of Vaccination

• Ideally, pneumococcal vaccines should be administered before initiating Skyrizi therapy when possible
• If not given before, vaccines can be administered during Skyrizi treatment
• For optimal immune response, consider administering at least 2 weeks before starting immunosuppressive therapy 1

Rationale and Evidence

Skyrizi (risankizumab) is an IL-23 inhibitor that can potentially affect immune responses. Patients on immunosuppressive medications like Skyrizi are considered immunocompromised and are at increased risk for pneumococcal disease.

The 2023 Advisory Committee on Immunization Practices (ACIP) guidelines recommend pneumococcal vaccination for all adults with immunocompromising conditions, including those on immunosuppressive medications 1. These recommendations are based on evidence showing that:

1. Immunocompromised individuals are at higher risk for invasive pneumococcal disease
2. Pneumococcal vaccination can reduce this risk, even in immunocompromised patients
3. The benefits of vaccination outweigh the potential risks 1

Special Considerations

Vaccine Effectiveness

• Vaccine effectiveness may be reduced in immunocompromised patients compared to immunocompetent individuals
• Despite potentially reduced effectiveness, vaccination is still recommended due to the higher risk of severe pneumococcal disease in this population 1

Safety

• Pneumococcal vaccines are inactivated and considered safe for immunocompromised patients
• No evidence suggests increased adverse events in patients on IL-23 inhibitors like Skyrizi

Revaccination

• For patients who previously received PPSV23 but not PCV, a dose of PCV20 should be administered at least 1 year after the last PPSV23 dose
• For patients who previously received PCV13, a dose of PCV20 can be given to provide broader serotype coverage 1

Important Clinical Considerations

• Document vaccination status in the patient's medical record
• Do not withhold vaccination if the patient's vaccination history is uncertain 2
• Monitor for any adverse reactions, although serious adverse events are rare
• Consider the patient's complete vaccination needs beyond pneumococcal vaccines, as patients on immunosuppressive therapy may need other vaccines as well

Pneumococcal vaccination is a critical preventive measure for patients on Skyrizi, as it can significantly reduce the risk of invasive pneumococcal disease and associated morbidity and mortality in this vulnerable population.