Vaccines and Psoriatic Disease: What You Need to Know Transcript
“Welcome to this episode of “Psoriasis Uncovered™”, a podcast series produced by the National Psoriasis Foundation, the nation’s leading organization for individuals living with psoriasis and psoriatic arthritis. Join us to hear our guest speakers uncover topics that lead to a better understanding of the disease and management, to coping and thriving with psoriasis and psoriatic arthritis.”
Jeff: My name is Jeff Brown.
LB: And I'm LB Herbert. We'll be your moderators for today's update on vaccines and psoriatic disease with dermatologist Dr. Jason Hawkes, who is a co-owner, Chief Scientific Officer, and investigator with the Oregon Medical Research Center in Portland, Oregon. He is also a member of NPF's Medical Board.
Jeff: Welcome Dr. Hawkes. It's a pleasure having you on Psoriasis Uncovered, formerly Psound Bytes, where you previously were a guest speaker addressing the immune pathways associated with psoriasis in episode #180. Vaccines can be confusing for anyone, but for those with psoriatic disease who may be on systemic treatments such as a biologic, JAK inhibitor, or methotrexate, there are even more questions. Dr. Hawkes, to start off with our discussion about vaccines, I was hoping you'd start with the basics. What is a vaccine and how does it work in one's body?
Dr. Hawkes: It's a great question and one that has a long history. You know, we've had vaccines since 1796 when Edward Jenner discovered vaccination and immunization with smallpox and we've obviously had a lot of development since then. But if you look at vaccines overall, these are a way to protect the body or help stimulate protection in the body against common infections or pathogens, so bacteria, viruses, and there's different types which we can certainly get into. So not all vaccines are functioning the same or how they're created. They're not all the same. But overall, the concept is to confer protection to the individual that wants to have protection against some of these infections. If you look at the history of vaccines as a whole and really back up to that 30,000 foot view, vaccines have saved more lives than any other medical invention in the world in history.
LB: I'm curious, do vaccines provide the same level of protection in people with an immune mediated disease such as psoriatic disease, especially for those on treatment that could affect the immune system?
Dr. Hawkes: Yeah, we need to break that up a little bit. If we take patients who have psoriasis who are not on any other medications, their immune system compared to someone without psoriasis is overactive. So instead of being, let's say, on a scale of one to 10, a three or a four, where it's giving them protection. It's not low. They're not immunosuppressed. Their immune system is very high, like a nine or a 10. And that's the reason they have their psoriasis. Their immune system's overactive. It's attacking their skin as well as other parts of their body. So their immune system's overactive and actually many patients will tell you “I rarely get sick” and this might be part of that where their immune system's overactive. It's giving them this extra level of protection overall. And when patients with psoriasis get vaccines, we think that they actually have a pretty good response. So we think in the absence of immunosuppressive treatments where patients with psoriasis that's untreated, for example, we think their immune response is normal. Their response to a vaccine should be good, just like the rest of us. It's a very different question when we talk about psoriasis patients who are on medications to help their psoriasis. Those medications, by definition, are going to lower their immune system. We're not trying to make them zero on that scale of one to 10. But we're trying to bring them back down to normal. So by bringing them back down to normal, we're helping shut off their psoriasis. And so we are lowering their immune system, but again, we're bringing them back down to normal. The problem with those medications is that while they help the psoriasis, they might interfere with our ability to develop that protective response to a vaccine. So we're not worried so much about psoriasis patients on psoriasis therapies having a bad outcome from the vaccine, like getting a live infection. We're worried about them not having the protective response that we want them to have. So, for example, we give them a vaccine against pneumonia. We're not worried about them getting pneumonia because of their psoriasis medication. We're worried about them not developing protection against pneumonia because we've hampered their immune response to some degree by the anti-psoriasis medication. So overall, if you have psoriasis, your vaccine response should be good. If you're on a medication, it's possible that medication could interfere with your vaccine response. But we know that there are many medications, so then we kind of have to get into the specific medications to start to understand whether it's going to have an effect or not.
Jeff: We sometimes hear our doctors or other healthcare providers talk about live versus non-live vaccines. As a member of the NPF’s Medical Board, you were part of a consensus statement that identified evidence-based vaccine recommendations for people receiving biologics and oral therapies. Dr. Hawkes, could you explain the difference between live versus non-live vaccines and what is the guidance for when people living with psoriatic disease should or should not receive them?
Dr. Hawkes: Let's take this in two parts. What's important is there are different type of vaccines, just like there are different type of psoriasis medications. So when we talk about the vaccines, we're talking about live vaccines or non-live vaccines. Now another term that you might hear with live vaccines are attenuated vaccines or like weakened pathogens. So what this means is that we are giving in the vaccine an exposure. So we give an injection to a patient and that's going to be weakened bacteria or a virus, for example. It's living, but it's weakened. Something's happened to prevent it from causing a full infection. And the advantage to that live vaccine is that you've got that whole organism, the whole virus. It's not able to cause disease in the same way because we've weakened it or attenuated it. But it's still alive. It's living. And these live vaccines have the advantage of giving the body a full exposure to that living organism, and they get a very robust immune response. So the advantage to the live vaccine is that you get all this exposure to the live bacteria or virus, and your body has a chance to really experience that pathogen and develop a really good response. And this often results in memory, which is the ability of the body to remember the response to that live vaccine. Now a non-live vaccine is the opposite. The virus from the vaccine doesn't have the ability to really cause the disease in the same way. So an inactivated vaccine could be a living virus that's really not capable of causing infection at all. And the problem with that is while it still has some live component to it in terms of the organism, it doesn't really have the ability to cause infection, which we would call non-live vaccine and the problem there is we have to have multiple doses of that same vaccine to get the same response. So we kind of take out the risk of live versus non-live because the non-live doesn't have the ability to cause the infection. We limit the ability of the body to fully respond. There's a whole host of non-live vaccines, including what people probably became most familiar with was the mRNA vaccines or the COVID vaccine. This is another form of a non-live vaccine. Now in the NPF recommendations, because of the nuances of the different vaccines and the nuances of the different medications, the Delphi group or this group of experts to vote on where they felt was the recommendations for these vaccines, obviously you have to take in account the different types of medications. And this was separated into two groups, which was the oral medications or we call oral systemic medications. So things like deucravacitinib or apremilast or methotrexate, cyclosporine, acitretin. These are some of the common oral medications versus the biologic medications. And basically we went through each of those and made some recommendations on where we felt these medications fit in that decision that patients have to either get live vaccines or non-live vaccines, and that recommendation we've created a table where we can actually look at the individual medications and make some recommendations based on how that consensus saw these medications effect on vaccines.
Jeff: Given what you've said so far, I realize the recommendations from the NPF are somewhat nuanced. Can you give a high level summary of examples of specific medications and how they might differ?
Dr. Hawkes: Yeah, of course we can't get into all of the details as there are a number of medications where for each medication in the oral and the biologic classes, we make specific recommendations as a group on how we should handle that specific medication for non-live vaccines and live vaccines. And for the specific information, we can talk a little bit about the biologic medications, and I think we can put these in two big categories. So let's first talk about the specific medications with regards to non-live vaccines. So these are gonna be things like COVID vaccine, hepatitis B vaccine, injectable influenza. It's important 'cause you can get influenza vaccines different ways, but this is the common flu shot injectable. Also Shingrix, pneumococcal vaccine, and even tetanus. So if you're on a TNF inhibitor then we don't recommend that patients interrupt or change their TNF inhibitor. So you can get those vaccines without having to do any change or modification to your dosing for that medication. And that's true with the IL-23/IL-12 inhibitor ustekinumab or Stelara® for example. That's true with the non-live vaccines for IL-17 inhibitors. So that would be Cosentyx®, secukinumab. Also ixekizumab or Taltz®, but also Siliq® and brodalumab. And even one of our newest medications, bimekizumab, which blocks IL-17A and F or Bimzelx® and our IL-23 inhibitors. So those would be Risankizumab or Skyrizi® or guselkumab, Tremfya® or also tildrakizumab and Ilumya®. These medications don't require interruption for the non-live vaccines. And if we then go back and say, well what about the live vaccines? And this is where it's a little bit more nuanced. The recommendation is that there's a period of time before the administration and a period of time that you want to wait a little bit after where we're going to hold these medications and they're going to differ by what we call the half-life and the half-life is how much time has to elapse where half of the medication is removed from your system. So right when you get your shot, it's at 100% and there's a period of time where it's going to drop from 100% down to 50%. That's one half-life. Now a second half-life is what about when it goes from 50 to 25% and that would be two half-lives to get down to 25%. And the reason that concept's important is because in general we usually think it's about 5 half-lives for most of the medication to leave the body. So if it was half-life was one day for a medication. It would take five days for that medication to be out of the system. And that concept in general gets at this idea that there's a period of time that has to pass for that medication to kind of get low enough in our system. And so the recommendation for most of the live vaccines with these biologic medications is that we usually want to wait two to three half-lives before the live vaccine so that allows the medication for our psoriasis to go down a little bit in our body, not to 0. But that helps take away that interference with the immune response and then we wait for a period after to let the immune response evolve and for that that live vaccine to slowly dissipate from the system before we restart it. So I can't give you the specifics for each of the individual medications because the recommendation is a general concept that you have to apply to the individual medication because they each have different half-lives. And so again the high level take home is that for the non-live vaccines for most of the medications that are biologics you can continue your medication as usual without having to change it for your non live vaccines. But for the live vaccine then you want to consider this period of interrupting it and holding it a little bit after the vaccine. And that's going to be specific to your medication. And again, that's the reason we want to incorporate the specialists into this conversation, like the dermatologist and the rheumatologist who can help guide primary care to help making the decision on what's the timing of the schedule that we're going to build around this live vaccine.
LB: So we see plenty of news articles and commercials for vaccines with each having their own guidance of when someone should receive them. For those with psoriatic disease, are there vaccines that are recommended to be received outside of these typical parameters? I know that before I started on a biologic, my rheumatologist had me receive a few vaccines that I wouldn't normally have received until later in life, just so I'd be protected once I went on the biologic.
Dr. Hawkes: Some of the vaccines that patients sometimes ask us about are those that are generally recommended at certain ages. And this probably happens more commonly in our adulthood time periods because we often receive vaccines through childhood and our pediatric time, which is a period where we less commonly have psoriasis. So while we know psoriasis can happen at any age, it's much more common in sort of the middle adult years, let's say between 20 and 40 and then later in life between 50 and 70. So we usually don't face this as commonly in very young children or pediatrics when they're normally getting the routine vaccines. But it does become an issue later in life when we have a patient who either newly develops psoriasis or has had psoriasis for many years and is either considering going on an anti-psoriasis medication or is already on one and say their primary care internist recommends a vaccine. Then we sort of have to make this decision. Some of the common ones you might hear about RSV which is usually recommended over age 60, but for individuals who are 50 and older who might be immunocompromised or have other autoimmune conditions may be recommended between 50 and 60. Two other common ones that kind of falls in that same age range as, which is pneumococcal protection against pneumonia and also Shingrix which is against Varicella to help give us protection against shingles which can come up obviously in later life. So these are three common vaccines that for those of you with psoriasis or adult patients in that age range, then you're either going to have a recommendation to get it before you go on a systemic medication, for example oral medications or the biologics for psoriasis. So if a patient were to receive methotrexate, which is a broad acting immunosuppressant sometimes required by insurance companies before patients can go on biologics. We usually make recommendations for those patients that they want to hold their methotrexate either prior to their vaccine or do the vaccines before they get that medication because we know methotrexate has a broad impact on the immune system. So if you're on methotrexate and then you got a vaccine, again, our worry isn't that you're going to get sick from the vaccine. Our worry is that you're not going to develop the protection from that vaccine. But that's going to be very different than some of our newer medications where we don't have the evidence that these biologic medications are going to interfere with those vaccines and the question we have in this area that these newer medications for psoriasis are very targeted and we just don't have the type of information that we do with some of the oral systemic medications. So if you're let's say, 48 or 49, and you're going to be considering one of these medications, you might want to get it early so that there's no chance of the anti-psoriasis medication interfering with your body's ability to protect you against these bacterial and viral infections. Now later, let's say you're 52 and you're on an anti-psoriasis medication and it's brought up that “oh, you know, a couple years ago you should have gotten one of these, or at least they're recommended” and you want to get those medications then what we can do from our list from the NPF recommendations, we can actually look at how your specific medication for psoriasis works and then we can go back to the recommendations. Again, these vary because they don't act the same on our immune system. And we can then look at what's the time period for where we need to either hold the medication before you get the vaccine and/or hold the medication for a period of time after to allow the body to develop that protective response that we hope to give. So overall, we're not recommending that you get vaccines that we wouldn't recommend to someone else in the age-related recommendations if you have psoriasis versus not psoriasis. We're treating them the same, but we are going to have that conversation like if you need a vaccine in a year, maybe we do it now before we put you on your anti-psoriasis medication.
Jeff: And Dr. Hawkes, you mentioned the mRNA vaccine, which had been in development for years. How do the mRNA vaccines work in comparison to the other vaccines you mentioned? There seems to be a lot of confusion about the mRNA vaccines lately, but yet if you don't have the vaccine, risks associated with getting COVID are far greater.
Dr. Hawkes: Yeah, this is an important question and it's challenging because, you know, it's been politicized to some degree and there's been some misinformation and we've also seen the pandemic in general has sort of this negative experience for a lot of reasons that are understandable. We either had people that we lost, loved ones, or individuals had some complications from the COVID vaccine. It was a difficult time and I think unfortunately this gave the mRNA vaccines, it left kind of a bad taste in a lot of people's mouths with regards to the science. But if we back up a little bit and take out some of the politics for the specific event, then we can understand a little bit about how these vaccines work. Now the vaccines we've talked about before all include having either a part of an organism, a virus or bacteria, or a living bacteria or virus, and then giving it to your body. Letting your body get used to it and start to develop a response as if you got the infection without getting the disease, and then develop a response. The mRNA vaccines are a little bit different because they take a piece of the genetic material, which we call RNA. And we can put these in, for example, a nanoparticle. This would be a good example of the Pfizer COVID vaccine, where we put a little bit of the RNA inside this nanoparticle, a small particle, and we can deliver it to the body inside a cell. That cell can start to develop a very unique response, very specific response to that particular infection or virus. And the advantage to this type of vaccine is that one, it can be developed with very high specificity meaning that we can make it target one thing really well. But they also can be created very quickly and they're also very easily adaptable, meaning that we can modify it. So one of the experiences we had with COVID vaccines, the mRNA vaccine, Pfizer for example, is that we were able to develop the vaccine quickly. I think that was one of the positives of what we had in the pandemic is that we were able to create a very rapid turnaround in delivering protection. So for the future, we have a technology that can be very quick. We were able to adapt it to the specific virus so that was protecting you against COVID for example. And then as it adapted, we were able to adjust that mRNA that was being delivered to the body so that it was evolving as the virus is evolving because the real problem with these pathogens, these bacteria, viruses that they can evolve. So we learn this with the flu, right? Every year people are getting flu shots that are slightly different than the one before because that virus is changing. So again, the high level with the mRNA vaccines is they're delivered by these small nanoparticles. You can also put them inside a harmless virus to help get them into the body. That was true with Astra Zeneca or the Johnson Johnson vaccine. We can adapt them quickly and we can develop them quickly. And so while it's a new technology, it's very powerful in our ability to respond to these unpredictable events through history where we might get exposure to new infections. We have this ability to quickly respond, but then slightly adjust it over time. And we're going to learn more about this over time because without a doubt there's going to be future infections that we're going to need to develop some protection against because we haven't been exposed to it.
LB: Thank you Dr Hawkes. So I'm curious, does being on a systemic treatment change how long immunity from child vaccines last, and I wonder if I should receive additional childhood vaccines again?
Dr. Hawkes: Yeah, this is a really great question and an important one because it's getting at this concept of once I had protection in my childhood I received these vaccines. Maybe that was before the psoriasis. And maybe that was even before being on any anti-psoriasis medications. And the question now is that by being on these anti-psoriasis medications, is it undoing or reversing some of the protection that we had in our early childhood or early adulthood? And the answer is no, it really doesn't take away whatever immune response you developed early in your life. And one of the core components to the immune response is memory. So once we teach the body to respond, depending on how we taught the body to respond and protect us against the bacteria or virus, that protection can be lifelong in some cases. In others, we just have to periodically re-up on it and get a boost. So you hear about boosters with things like tetanus or diphtheria, for example. But we often don't have to get vaccines again for things like polio. So bottom line is that if we've had a good immune response early in our life prior to psoriasis and or the systemic medications for psoriasis, then going on these medications in the future aren't going to undo that. The question then becomes, now that I have psoriasis and I'm on an anti-psoriasis medication, what's the impact of that specific medication on my risk for a future infection, either a virus or a bacteria and if you had your prior immune response developed against a particular infection, then going on a new medication doesn't necessarily take that away. But the psoriasis medication can still make you at risk for other types of infections. We know that there's a slightly increased risk of shingles from being on the anti-psoriasis medication. Normally we get an infection with chickenpox or varicella in childhood, that's the same virus that causes chickenpox later in life can cause shingles. But we know that being on that medication for psoriasis might increase your risk of that. So it becomes even more important to have, for example the Shingrix vaccine. Not because we didn't get protection from Varicella, but because that virus can stay in the body and it can come out later in the form of shingles. So by being on that medication for psoriasis we increase our risk of it just a little bit above people without psoriasis. So that's where we want to be thinking about getting that extra protection.
LB: Dr. Hawkes, would you say the guidance you've given for psoriasis also carries over into psoriatic arthritis?
Dr. Hawkes: Great point to bring up because sometimes when we talk about psoriasis, it's not clear are we only talking about plaque psoriasis or are we also talking about patients with psoriatic arthritis or both. And the answer is that in the recommendations, these apply to patients with psoriasis and/or psoriatic arthritis. So the recommendations that we make for the different classes of medications can be applicable equally to both groups. So whether you have just skin disease or just joint disease or both, these recommendations are going to be applicable. The one thing I'll say about the difference between plaque psoriasis and psoriatic arthritis is that your likelihood of being on an oral systemic medication like methotrexate for example is actually higher if you have psoriatic arthritis, and that gets into some of the differences between some of the rheumatologists and also the dermatologists. But also the fact that some of our really targeted biologic medications don't always work really well for the joints even though they work very well in the skin. So for that reason, even though again the validity of these recommendations are the same for plaque psoriasis and psoriatic arthritis there's a chance that your situation could be a little bit more complicated because sometimes to get the joints under control, we have to add medications to the biologic medications like methotrexate or even sometimes patients will be on low dose oral steroids. Because of the combination, it makes it a little bit more complex. And if you look at biologics versus the oral systemics, so things like cyclosporine, apremilast, methotrexate. In general these oral medications are going to have a bigger, broader response on the immune system, which are going to make recommendations a little bit more conservative. So even with non-live vaccines we'll have some recommendations for the oral medications to hold even for the non-live, whereas we don't see that with the targeted biologic medication. So I think for our patients who have psoriatic arthritis, we just want to pay particular attention, am I also on something else that's going to have an additional impact on my ability to mount a protective immune response in addition to my biologic because sometimes they're on combination therapies and that would be the only difference. But again, if you looked back at this chart, we said, well, we have a biologic and oral systemic, we want to err on the side of the recommendation for the medication with the biggest impact. So if you're on a very targeted biologic and an oral medication and the biologic said you didn't have to change it for a vaccine but the oral did, we wouldn't want to err on that side because again, we don't want to get a vaccine and not get the protection we were trying to gain if the oral medication that was added to the biologic might interfere with that. So practically the exposure to different medications for skin only and joints only, or skin and joints is is a little bit different. So you want to pay attention to that. Good question.
Jeff: So, Dr. Hawkes, who should someone with psoriatic disease turn to for vaccine guidance? The dermatologist, rheumatologist, primary care doctor, or a pharmacist?
Dr. Hawkes: Each of these individuals may have a role, and it's probably important to at least have the conversation with multiple members. And here's the reason for that. Dermatologists are really good at psoriasis, and we're really good at the medications that we recommend for patients, we know them inside and out. We've had experience with all of them and we can at least go back and make very specific recommendations about which vaccines you might want to consider and how your current psoriasis medication might impact your immune response for that vaccine, the intended response, the protection that we want to give you. The problem is that we're often not the ones to give those vaccines, and we may not be as readily accessible as a primary care or an internist, for example, who may be really tracking as part of their usual workflow to make sure you're getting the vaccines you want. So in general, I think that primary care and our internists are really the gatekeepers for a lot of the vaccines. So they're going to be the ones that say, here's the vaccine I think you need, and here's the time points that we're going to target. The problem is they don't really understand the medications that we use. So your primary care doesn't really know the difference between the TNF inhibitors or the IL-17s or the IL-23s or even some of the newer oral systemic medications, things like deucravactinib or even apremilast. So the downside to that group is making all the decisions they can't really make the recommendation. And then they may have you stop the medication for a prolonged period of time, or they may tell you to not get the vaccine because they're not sure what kind of impact it's going to have. And so I think there's really a balance between having the general information to try to gauge what are the vaccines that I need to consider or should get? And then balance that with the specialist information, whether it's the dermatologist or the rheumatologist, to say, well, let's look at that vaccine, let's talk about it and let's place it into the category with your specific medication that we're either considering to see if there's a recommendation to either hold it or just keep that medication going and get your vaccine. And we can help make that recommendation. So I really think it's a combination of both and the pharmacist has a lot of general information. They almost never give medical advice, which is really what patients are seeking. And they have a good understanding of how the medications work, but they really don't have a good understanding of how the diseases work, I think the nuances of clinical care. So overall, talk to your primary care or generalist doctor. Make sure you also have the conversation about your specific medication and make sure your specialist is involved because the specialist, the rheumatologist, the dermatologist for example, can make some very strong recommendations on how to manage your psoriasis medication, in light of the vaccine or immunization that you may be considering.
LB: And if someone is unsure about vaccines, what questions should they bring to their next appointment or conversation with their health care provider?
Dr. Hawkes: This is just really having that open dialogue with patients and their providers to talk about what concerns may exist. For patients it might be do I really need vaccines? Are they safe? Is it going to make my psoriasis worse? Those might be some common questions that patients have. And for the provider hearing what those concerns are or having an open dialogue about those concerns, I think we can find that common ground that's going to be important. Our goal is to always help the patient manage their disease and to do it in the safest way possible. Doesn't mean that we require all patients to have vaccines. Or that we won't respect their wish to maybe not pursue vaccines. But we certainly want to make sure that the concerns that they have aren't founded on inaccurate or incorrect information. We want to make sure we're having the dialogue to give them the most accurate information so they can make an informed decision. But we're always going to respect the patient's decision as they're really the gatekeeper of their own health. We're just there to be of assistance and to give the guidance as to what we should do with regards to immunizations or vaccines in the setting of your psoriasis and also the anti-psoriasis medication that you're either considering or may already be on.
Jeff: So, Dr Hawkes, are there any new vaccines or research and development that people with psoriatic disease should be aware of?
Dr. Hawkes: Yes, as we've gotten to more targeted medications for psoriasis, but also as we've really started to uncover the key mechanisms driving psoriasis and also psoriatic arthritis. And as the science has evolved, some of the clinical trials have also evolved where as we study these medications, some of the clinical trials don't allow you to have vaccines, others allow vaccines, particularly the non-live vaccines. And we also have different registries and different groups that are tracking patients who have psoriasis are on these anti-psoriasis medications and who get vaccines even despite the recommendation. So a good example of this is a patient doesn't think about their psoriasis medication or their primary care isn't aware they're on it. That happens, I think more frequently than we like to admit, but they may have received a live vaccine even though they've had psoriasis and were on one of these anti-psoriasis medications. But we can learn from those examples, and that's one of the points of having some of these registries where we can learn, well, if somebody did get one of these vaccines on a particular medication, what happened? Was it safe? Did it lead to a problem? How good is their immune response? Was it OK? And I think what we've learned in some of these situations, particularly some of the older medications, is that some of these live vaccines that were given on these anti-psoriasis medications showed to be safe and their immune response was pretty good. And this has generated a lot of interest in maybe even conducting a few studies where patients with psoriasis are actually given different types of vaccines with different medications for their background psoriasis and to start to understand how their immune response is, and this is important because just like pregnancy or lactation, they get excluded from the study. So it's not that we don't know that they're safe versus harmful, it's just that we just don't have any information there. It's a paucity of information. So we can't make recommendations. So by starting to study this proactively in a longitudinal way, we can give these patients with psoriasis who are on specific medications, we can give them vaccines and see how their immune response is. So I think this is going to happen in the future just like we're starting to see studies where patients are on their psoriasis medication even while they're pregnant or breastfeeding. We're going to start to learn which medications have the greatest impact and which ones don't. And this is a fine balance between advancing science and not causing harm. But this is going to be the future as we start to understand how this is going to work and also as the vaccine science improves over time, there may be ways that we can stimulate immune response that are less susceptible to some of the ways that the anti-psoriasis medications work. So I think in the future this is going to be a very important hot topic that's going to keep coming up as we advance our understanding in the psoriasis area, the treatments, but also the vaccines.
LB: Thank you Dr. Hawkes, for being here today to provide such interesting updates on vaccines and how they are still important and safe for most people with psoriatic disease. Do you have any final comments you'd like to share with our listeners?
Dr. Hawkes: Yeah. Overall, the recommendation I would make for the listeners here with psoriasis and their medications is to really develop a good relationship with your provider. Find a provider who you feel comfortable with, that you can talk to about your disease, you can talk to about a specific medication. That you're not afraid to say I have questions or I have concerns or do you really think this is necessary? I think when you look at what's the overall goal of developing your relationship with your provider is to optimize your ability to get better, and also to have that relationship that when things go up or go down at times, we know they change, that you have someone in your corner that will really advocate with and for you. And I think with regards to vaccines, the big take home here is that we know that overall while the immune system's overactive in psoriasis patients, we know the immune system's otherwise in good shape. It's ability to form protection against bacteria and viruses is quite good. We just need to balance the fact that as we age in particular, we lose some of that protection and these vaccines allow us to kind of bolster or beef up that immune response to help protect us. And so we don't want to throw out the entire bucket of vaccines and immunizations because that puts our overall health at risk. And we don't want to say because I'm on a psoriasis medication, I shouldn't get any vaccines because there's a way to balance that as well. You might have a short interruption on your therapy, get the vaccine. We're talking a couple of weeks, two to four weeks, for example, and then hold for a little bit on your medication for psoriasis before you restart it. And because these medications for psoriasis are getting better and better usually those short interruptions don't lead to a big change or worsening of your psoriasis. So the fear patients often have is that if I stop my medication for a short period of time to get this vaccine to give me some extra protection that I might need in the future. Their concern is that their psoriasis is going to get a lot worse or flare, but usually it doesn't. And for these short periods of time, we can balance those two things. And so again, you need to have a provider that really knows your medication, knows what your personal beliefs and thoughts and concerns are. And then create a very tailored plan where we can navigate all these complexities so that we can optimize the best outcome, treating the psoriasis, managing the psoriasis and still giving you the added protection you need. As our immune system declines over time and gets weaker and get more susceptible to things like pneumonia or shingles, we want to help you get that added protection. So, I think overall this can be a very positive strategy for collaborating together and getting a very good outcome knowing that we have very safe strategy for bringing psoriasis, psoriasis treatments, and vaccines together.
Jeff: Thank you again, Dr. Hawkes, for this very timely and important discussion. For our listeners, please share this episode link with anyone you know who is questioning when or whether they should receive a vaccine when taking a systemic medication for psoriatic disease.
LB: For more information about treatments and vaccines, contact our Patient Navigation Center at education@psoriasis.org. And finally, thank you for listening to Psoriasis Uncovered, where we uncover what you need to know about psoriasis and psoriatic arthritis.
We hope you enjoyed this episode of Psoriasis Uncovered for people living with psoriasis and psoriatic arthritis. If you or someone you love has ever struggled with psoriatic disease, our hope is that through our podcast you’ll gain information that inspires you to lead a healthy life and look to the future. Please share the episode link if the content in today’s episode will benefit someone you know.
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