Art of Prevention: Our Approach to the Measles-Mumps-Rubella (MMR) Vaccine in Adult Patients Vaccinated Against Measles Before 1968 on Biologic Therapy for the Treatment of Psoriasis

Abstract Background In response to the evolving measles epidemic in the United States the Center for Disease Control recommended that some adults be revaccinated against measles as they may have inadequate immunity against the virus. Patients receiving biologic medications for psoriasis face a clinical dilemma as they may be at an elevated risk of developing severe measles; however, vaccination with the measles-mumps-rubella vaccine is not recommended by the American Academy of Dermatology-National Psoriasis Foundation guidelines while on biologic therapy. Objectives Review the available research on the safety and efficacy of live-attenuated vaccines in individuals receiving biologic therapy for psoriasis. Discuss our approach to vaccinating individuals on biologics for psoriasis with the measles-mumps-rubella vaccine. Methods A review of the literature was performed via PubMed search. Our institution’s anecdotal experience is also discussed. Results/Outcomes/Improvements Data, although limited, is available suggesting that live-attenuated vaccines may be safe for individuals on TNF-alpha inhibitors for psoriasis. Inadequate data is available for patients receiving other biologic medications. Conclusion Providers should engage in shared decision making to determine whether patients on TNF-alpha inhibitors for psoriasis should receive the measles-mumps-rubella vaccine without an interruption in biologic therapy.