Can Shingrix Be Administered While on Dupixent?
Yes, Shingrix can and should be administered to patients taking Dupixent (dupilumab), as it is a non-live recombinant vaccine that is safe for use in patients on immunosuppressive or immunomodulatory therapy.
Rationale for Safe Administration
Shingrix is a recombinant zoster vaccine containing only a varicella zoster virus glycoprotein E antigen with the AS01B adjuvant system—it contains no live virus and therefore cannot cause infection under any circumstances, even in immunocompromised patients 1
Multiple guidelines explicitly recommend Shingrix for patients on immunomodulatory therapies, including biologics like dupilumab, as part of comprehensive vaccination strategies 2
The British Society of Gastroenterology guidelines specifically state that "recombinant zoster vaccination (Shingrix) is recommended for all patients receiving advanced therapies," which includes biologic agents 2
Vaccination Schedule While on Dupixent
Administer the standard 2-dose series with doses given 2-6 months apart (minimum interval of 4 weeks if needed) 2, 3
For patients already on immunomodulatory therapy like dupilumab, the AGA guidelines recommend a shortened interval of 4-8 weeks between doses to ensure earlier protection 2
The vaccine can be administered at any time during dupilumab therapy—there is no need to hold or delay the biologic 2
Important Clinical Considerations
Do not use the live-attenuated Zostavax vaccine in patients on dupilumab or any immunosuppressive therapy—only Shingrix is appropriate for this population 2, 1
Dupilumab is an IL-4/IL-13 inhibitor used primarily for atopic dermatitis, asthma, and chronic rhinosinusitis, and while it modulates immune responses, it does not contraindicate inactivated or recombinant vaccines 2
The vaccine response may be somewhat reduced compared to immunocompetent individuals, but vaccination still provides meaningful protection and is strongly recommended 2, 3
Safety Profile in Immunomodulated Patients
Studies in patients with autoimmune conditions on immunosuppressive therapy showed only mild disease flares (4-17%) after Shingrix vaccination, with no serious adverse events 3
Common side effects include injection-site reactions (9.5% grade 3 reactions), myalgia, and fatigue (11.4% systemic symptoms), but these are transient and typically resolve within 4 days 3, 4, 5
No serious safety concerns have been identified in large clinical trials, with similar rates of serious adverse events between vaccine and placebo groups 3, 4
Practical Implementation
Administer Shingrix at a separate anatomic site if giving other vaccines concomitantly 2
Counsel patients that local reactions and systemic symptoms are common but do not represent infection or disease flare 4
Complete the 2-dose series for optimal protection—real-world effectiveness is 70.1% for the complete series versus 56.9% for a single dose 6
If the patient is ≥50 years old (or ≥18 years if immunocompromised), proceed with vaccination without delay 2, 3