Tremfya and Vaccine Effectiveness
Tremfya (guselkumab), an IL-23 inhibitor, appears to have minimal to no significant impact on vaccine effectiveness and can be continued without interruption during vaccination. 1
Key Recommendation
Continue Tremfya during vaccination without dose adjustment or timing modifications. 1 The 2022 American College of Rheumatology guideline specifically recommends continuing immunosuppressive medications other than methotrexate and rituximab during non-live attenuated vaccination, which includes IL-23 inhibitors like Tremfya. 1
Evidence Supporting Continued Use
IL-17 and IL-23 Pathway Blockers
Anti-TNF agents and IL-17 blockers show no significant effect on vaccine-induced immunity unless used concurrently with methotrexate, and guselkumab (an IL-23 inhibitor) functions through a related but distinct mechanism. 1
The CDC recommends at least a two-week spacing between administration of certain biologics and vaccination, but this guidance primarily targets TNF inhibitors, IL-6 inhibitors, and T-cell activation inhibitors—not IL-23 inhibitors like Tremfya. 1
Unlike medications that profoundly suppress vaccine responses (rituximab, high-dose corticosteroids ≥20 mg/day prednisone equivalent, or methotrexate), IL-23 inhibitors are not flagged as requiring special vaccination timing or antibody titer monitoring. 1
Practical Vaccination Approach
Non-Live Vaccines (Influenza, Pneumococcal, COVID-19, etc.)
Administer all non-live vaccines on schedule without interrupting Tremfya therapy. 1, 2
No dose adjustment, timing modification, or holding period is required for Tremfya around vaccination. 1
Consider high-dose or adjuvanted influenza vaccine if the patient is ≥65 years or 18-64 years on immunosuppression, though this recommendation is based on very low-quality evidence. 1
Live Vaccines
Avoid live vaccines entirely while on Tremfya, as the FDA label explicitly states to avoid use of live vaccines in patients treated with guselkumab. 2
Complete all age-appropriate vaccinations, including live vaccines, prior to initiating Tremfya therapy whenever possible. 2
Monitoring Considerations
Routine antibody titer monitoring after vaccination is not recommended for patients on Tremfya, unlike patients on rituximab or high-dose corticosteroids (≥20 mg/day prednisone or ≥2 mg/kg in children). 1
If the patient is on concurrent methotrexate, consider holding methotrexate for 2 weeks after vaccination if disease activity allows, as methotrexate—not Tremfya—is the medication that significantly impairs vaccine response. 1
Common Pitfalls to Avoid
Do not confuse IL-23 inhibitors with medications that require special vaccination timing (rituximab, high-dose corticosteroids, or methotrexate). 1
Do not delay indicated vaccinations waiting for an optimal window—the guideline emphasizes avoiding missed vaccination opportunities. 1
Do not withhold seasonal influenza vaccination even if disease activity is high, as timely influenza vaccination takes precedence. 1
Do not assume all biologics behave identically—rituximab profoundly impairs B-cell responses for months, while IL-23 inhibitors do not share this mechanism. 1
Safety Profile
The FDA label for Tremfya notes that no data are available on the response to live or inactive vaccines, but this reflects lack of specific studies rather than evidence of harm or reduced effectiveness. 2
Non-live vaccines administered to patients on biologics like Tremfya do not aggravate disease or cause serious adverse events compared to healthy subjects. 1