Can Patients on Rinvoq Receive Pneumococcal Vaccine?
Yes, patients taking Rinvoq (upadacitinib) should receive pneumococcal vaccination, but only non-live pneumococcal vaccines are appropriate, and timing considerations apply.
Vaccine Safety and Appropriateness
Pneumococcal conjugate vaccines (PCV15, PCV20, PCV21) and pneumococcal polysaccharide vaccine (PPSV23) are all non-live vaccines and are safe to administer to patients on Rinvoq 1. The FDA label explicitly states that patients should "avoid use of live vaccines" with Rinvoq, but does not contraindicate non-live vaccines 1.
Vaccination Recommendations for Immunosuppressed Patients
Patients on Rinvoq are considered immunocompromised due to JAK inhibitor therapy, which affects immune system function 1. For adults aged 19-64 years with immunocompromising conditions:
- First-line option: Administer a single dose of PCV21, PCV20, or PCV15 2
- If PCV15 is used: Follow with PPSV23 at least 8 weeks later (shortened interval for immunocompromised patients compared to the standard 1-year interval) 2
- If vaccine-naïve: PCV20 is preferred as it provides comprehensive coverage without requiring PPSV23 3
For adults aged ≥65 years with immunocompromising conditions, the same approach applies with similar vaccine options 2.
Timing Considerations
Ideally, vaccinate before starting Rinvoq when possible, as immune responses may be blunted once immunosuppression begins 4. However, if already on therapy:
- Administer pneumococcal vaccines while continuing Rinvoq—do not hold the medication 4
- Unlike rituximab or methotrexate, there are no specific recommendations to time vaccination around JAK inhibitor dosing 4
- Patients should inform their healthcare provider they are taking Rinvoq prior to vaccination 1
Expected Immune Response
Research demonstrates that approximately 67.5% of patients on upadacitinib 15 mg achieved satisfactory humoral response to pneumococcal conjugate vaccine (PCV-13) despite concomitant methotrexate use 5. This indicates that while immune responses may be somewhat reduced compared to immunocompetent individuals, meaningful protection can still be achieved 5.
Concomitant corticosteroid use did not further diminish vaccine responses in clinical studies 5.
Important Caveats
- Increased infection risk: Patients on Rinvoq have heightened susceptibility to infections, making pneumococcal vaccination particularly important for disease prevention 1
- Monitor for infection: Healthcare providers should test for tuberculosis before starting Rinvoq and monitor for signs of infection during treatment 1
- No live vaccines: Ensure only inactivated pneumococcal vaccines are used; live vaccines are absolutely contraindicated 1