Should vaccines be given before or after cosentyx?

Official Guidance on Vaccines and Cosentyx

Cosentyx (secukinumab), an IL-17 inhibitor for psoriasis, psoriatic arthritis, and ankylosing spondylitis, suppresses the immune system. Novartis, the manufacturer, recommends completing all age-appropriate immunizations before starting Cosentyx. Live vaccines should be avoided during treatment and for at least 4-6 weeks after the last dose due to infection risk.[1]

Live vs. Inactivated Vaccines: Key Differences

• Live vaccines (e.g., MMR, varicella, oral polio, yellow fever): Do not administer to patients on Cosentyx or within several weeks after stopping. The drug's immunosuppression can cause uncontrolled replication of live virus.[1][2]
  
• Inactivated or recombinant vaccines (e.g., flu shot, Tdap, HPV, COVID-19, pneumococcal): Generally safe during treatment. Administer them as scheduled, though antibody response may be reduced—booster doses might be needed.[1][3]
  
  | Vaccine Type | Before Cosentyx | During Cosentyx | After Stopping |
  |--------------|-----------------|-----------------|----------------|
  | Live | Preferred (complete full series) | Avoid | Wait 4-6 weeks |
  | Inactivated | OK if needed | OK | OK |
  
  

Timing for Common Vaccines

• Routine childhood/adult vaccines: Finish before starting Cosentyx to ensure optimal immunity.
  
• Annual flu vaccine: Give inactivated version anytime, even on therapy.
  
• COVID-19 vaccines: Safe before, during, or after; studies show reduced but present response in Cosentyx users—extra doses advised for high-risk patients.[4]
  
• Shingles (Zostavax, live): Avoid; use Shingrix (recombinant) instead, which is fine during treatment.[2]
  
  

What Happens If Vaccinated During Treatment?

No major safety issues reported with inactivated vaccines, but efficacy drops 20-50% for some (e.g., flu, pneumococcal). Live vaccines risk disseminated infection, though rare cases exist. Monitor for poor response via titer checks if high-risk.[3][5]

Patient and Doctor Considerations

Consult your rheumatologist or dermatologist—they may test immunity levels or adjust timing based on disease activity. CDC and ACR guidelines align: prioritize pre-treatment vaccination, favor non-live options.[2][6] No head-to-head trials compare pre- vs. post-dosing efficacy directly.

Sources
[1] Cosentyx Prescribing Information (Novartis)
[2] CDC Vaccine Guidelines for Immunocompromised Adults
[3] ACR Guidelines on Vaccinations in Rheumatic Diseases
[4] Study on COVID-19 Vaccine Response in IL-17 Inhibitors (JAMA Dermatology, 2022)
[5] EMA Cosentyx Summary of Product Characteristics
[6] UpToDate: Vaccinations in Patients on Biologics