Patients 18 and older# with psoriatic disease who received a second dose of the Pfizer-BioNTech five or more months ago or a Moderna COVID-19 vaccine six or more months ago* SHOULD get a booster shot.
Individuals who are eligible for a booster dose may choose which vaccine they receive as a booster. Some people may prefer the vaccine type that they originally received, and others may prefer to get a different booster. In most situations, Pfizer-BioNTech or Moderna COVID-19 vaccines are preferred over the Johnson & Johnson COVID-19 vaccine for primary and booster vaccination.
If receiving a booster dose with a Moderna vaccine, this should be half of the dose that is given for the primary series (i.e., first 2 doses).
# Children 12-17 years old can get a Pfizer-BioNTech COVID-19 vaccine booster 5 months after completing their primary COVID-19 vaccination series with a Pfizer-BioNTech COVID-19 vaccine.
*Patients with psoriatic disease treated with immunosuppressive or immune-modulating therapies such as corticosteroids, leflunomide, methotrexate, tofacitinib, apremilast, and biologics that target the cytokines TNF, IL-12/23, IL-17, and IL-23 or T cells (e.g., abatacept), are ELIGIBLE for a 3rd dose “mRNA COVID-19 vaccine as per the CDC, as soon as 28 days after the second dose of an mRNA vaccine. This eligibility applies to patients ages 5 and older (Pfizer-BioNTech vaccine) or in patients ages 18 and older (Moderna vaccine and Pfizer-BioNTech vaccine). Most patients receiving systemic treatment for psoriatic disease are not moderately to severely immunocompromised and would not require a 3rd dose at 28-days. Patients taking abatacept, cyclosporine, leflunomide, glucocorticoids (e.g., prednisone), methotrexate, or tofacitinib who have additional risk factors for poor COVID-19 outcomes may benefit from a 3rd dose of a mRNA COVID-19 vaccine. Patients who elect to get a 3rd dose of an mRNA vaccine may then receive a booster dose 5 (if the primary series was Pfizer and are 16 or older) or 6 (if the primary series was Moderna and are 18 or older) months after the 3rd dose. Shared decision-making between clinician and patient is recommended to guide discussions about use of 3rd doses of mRNA COVID-19 vaccines and booster doses of COVID-19 vaccines.
Patients 18 and older with psoriatic disease who received a single dose of the Johnson & Johnson COVID-19 vaccine two or more months ago SHOULD get a booster shot. This booster vaccine can be a Pfizer-BioNTech COVID-19 vaccine or a Moderna (half dose) COVID-19 vaccine which are preferred over the Johnson & Johnson COVID-19 vaccine.
The following patients most likely to BENEFIT from a COVID-19 booster vaccine:
• People aged 50 or older
• People taking abatacept, cyclosporine, leflunomide, glucocorticoids (e.g., prednisone), methotrexate, or tofacitinib
• People who received their second dose of an mRNA vaccine over 6 months ago
• People who received a single dose of the Johnson & Johnson vaccine over 2 months ago
• People with underlying co-morbidities known to increase the risk of severe COVID-19, such as being overweight, being a current or former smoker, or having diabetes, cardiovascular disease, chronic lung, liver, or kidney disease.
• People who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting; or who have routine contact with unvaccinated individuals (i.e., children) or routine contact with those at high risk for severe COVID-19 or infection (i.e., an elderly or immunocompromised household member).
It is recommended that patients who are to receive COVID-19 booster vaccine continue their biologic or oral therapies for psoriasis and/or psoriatic arthritis in most cases. Patients who are taking methotrexate with well-controlled psoriatic disease, may, in consultation with their prescriber, consider holding it for 2 weeks after receiving a booster vaccine in order to potentially improve vaccine response.