Patients with psoriatic disease treated with immunosuppressive or immune-modulating therapies that affect the immune system in a manner that may make a patient more susceptible to infection, 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 “booster” mRNA COVID-19 vaccine as per the CDC. This booster vaccine should be administered at least 28 days following the two-dose regimen of the SAME vaccine, and only to patients ages 12 and older (Pfizer-BioNTech vaccine) or in patients ages 18 and older (Moderna vaccine and Pfizer-BioNTech vaccine). CDC has not issued recommendations for boosters in patients who received the one dose Ad26.COV2.S vaccine manufactured by Johnson & Johnson.
At this time, it is not known whether these treatments for psoriatic disease affect the benefits of COVID-19 vaccines, which are proven to be highly effective in preventing severe COVID-19 illness in the general population. The COVID-19 vaccines are safe and, to date, neither the CDC nor the FDA have seen evidence of a safety signal for these vaccines in terms of flaring existing psoriasis. Shared decision-making between clinicians and patients is recommended to guide discussions about the use of a 3rd booster dose of an mRNA vaccine.
Studies demonstrate that a third dose of an mRNA vaccine increases immunogenicity in transplant recipients, but it is not known whether a 3rd booster dose of an mRNA vaccine will result in additional clinically important benefits for patients with psoriatic disease taking immunosuppressive or immune-modulating treatments. Patients taking an immunosuppressive or immune-modulating treatment for psoriatic disease are predicted to be more likely to benefit from a 3rd booster mRNA-based COVID-19 vaccine in the following circumstances:
1. People aged 50 or older, based on data from Israel.*
2. People taking abatacept, cyclosporine, leflunomide, glucocorticoids (e.g., prednisone), methotrexate, or tofacitinib, based on evidence of modest reduction in antibody responses to mRNA-based vaccines for some of these treatments, or theoretical concerns based on their mechanism of action.
3. People who received their second dose of an mRNA vaccine over 6 months ago.*
4. People with underlying comorbidities 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)*
*Based on data from the general population