Can patients on Dupixa (dupilumab) receive the influenza vaccine?

Dupilumab (Dupixa) and Influenza Vaccination

Patients on Dupixa (dupilumab) can and should receive the inactivated influenza vaccine annually without interrupting treatment. 1

Key Recommendation

The inactivated (intramuscular) influenza vaccine is safe and recommended for all patients on dupilumab, while the live attenuated intranasal vaccine should be avoided. 1

Rationale and Evidence

Dupilumab Does Not Require Treatment Interruption

• Dupilumab is a monoclonal antibody targeting IL-4 receptor alpha, blocking IL-4 and IL-13 signaling—it is not a traditional immunosuppressant like corticosteroids, TNF inhibitors, or rituximab. 2
• Unlike medications such as methotrexate or rituximab that significantly impair vaccine responses, dupilumab does not substantially compromise immune function for inactivated vaccines. 2, 3
• A systematic review by the American College of Allergy, Asthma and Immunology concluded that vaccines (including live vaccines) appear safe and effective in dupilumab-treated patients based on available evidence. 2

Influenza Vaccination is Critical

• Annual influenza vaccination is universally recommended for all persons aged ≥6 months, including those with chronic conditions. 1
• The inactivated influenza vaccine should be administered each autumn to patients on any immunomodulatory therapy. 1
• The optimal timing is September through November, though vaccination should continue into January or later as long as vaccine is available. 1

Vaccine Type Matters

• Use only the inactivated (intramuscular) influenza vaccine—this is non-infectious and safe for patients on immunomodulatory therapies. 1
• Avoid the live attenuated intranasal influenza vaccine (LAIV)—while emerging evidence suggests dupilumab may not contraindicate live vaccines as strictly as once thought 2, 3, current guidelines for immunosuppressed patients recommend avoiding live vaccines, and the inactivated option is readily available and effective. 1

Clinical Evidence Specific to Dupilumab

• Preclinical studies showed dupilumab (via surrogate antibody) did not affect live attenuated influenza vaccine efficacy in mice. 3
• In a clinical study, 37 patients with asthma who recently discontinued dupilumab received live attenuated yellow fever vaccine and achieved full seroprotection with no vaccine-related adverse events, even with therapeutic dupilumab levels present. 3
• Children with atopic dermatitis who inadvertently received live vaccines (MMR ± varicella) while on dupilumab showed no adverse events within 4 weeks post-vaccination. 4

Practical Implementation

Timing

• Administer the inactivated influenza vaccine at any routine visit during flu season without interrupting dupilumab therapy. 5, 6
• No need to delay dupilumab doses or adjust the treatment schedule around vaccination. 5, 6

Monitoring

• No special post-vaccination monitoring is required beyond standard vaccine safety surveillance. 2
• Patients may experience typical vaccine side effects (injection site reactions, mild systemic symptoms), but these do not indicate treatment failure or require dupilumab discontinuation. 7

Common Pitfalls to Avoid

• Do not unnecessarily delay influenza vaccination waiting for a "perfect" window—the inactivated vaccine can be given at any time during dupilumab treatment. 5
• Do not confuse dupilumab with traditional immunosuppressants like high-dose corticosteroids or rituximab that require more complex vaccination timing strategies. 1, 2
• Do not use the intranasal live attenuated vaccine—always specify the intramuscular inactivated formulation when ordering. 1