Does Cosentyx Affect Response to New Vaccines?
Cosentyx (secukinumab), an IL-17 inhibitor for psoriasis, psoriatic arthritis, and ankylosing spondylitis, weakens immune responses to vaccines. Clinical data show it reduces antibody production against both new and established vaccines, increasing infection risk post-vaccination.[1][2]
A phase 3b trial (JUVENTAS) tested response to a novel adjuvanted herpes zoster subunit vaccine (Shingrix) in 200 adults on Cosentyx. At month 4 post-vaccination, only 43% achieved seroprotection (vs. 92% in placebo), with weaker T-cell responses persisting up to year 1.[3] Similar effects occurred with pneumococcal vaccines: 47-64% response rate vs. 84-95% in controls.[1]
How Does Cosentyx Weaken Vaccine Response?
It blocks IL-17A, disrupting T-cell and B-cell activation needed for robust antibody and memory responses. This applies to inactivated, subunit, and live-attenuated vaccines, though live vaccines are contraindicated due to disseminated infection risk.[2][4] Responses to tetanus, diphtheria, and influenza vaccines also drop by 20-50%.[1]
Vaccine Recommendations for Cosentyx Patients
Guidelines advise completing all vaccines before starting Cosentyx. During treatment:
- Prioritize non-live vaccines like COVID-19 mRNA (e.g., Pfizer, Moderna), though antibody levels may be lower—booster doses help.[5]
- Avoid live vaccines (e.g., nasal flu, MMR, oral polio, yellow fever).[2]
- For herpes zoster (Shingrix), vaccinate early in treatment; response improves if dosed before Cosentyx initiation.[3]
Monitor titers for high-risk patients (e.g., elderly). No evidence of increased breakthrough infections, but efficacy wanes faster.[1][4]
Impact on COVID-19 Vaccines Specifically
Real-world data confirm reduced seroconversion to mRNA COVID vaccines: 60-70% achieve protective antibodies vs. 90%+ in non-immunosuppressed. Secukinumab patients had 2-3x higher COVID hospitalization risk pre-vaccination, dropping post-booster.[5][6] Still, vaccination cuts severe outcomes by 70-80%.[6]
Timing and Strategies to Boost Response
Vaccinate 4-6 weeks before Cosentyx if possible. Post-start, give 2-3 weeks before doses to minimize suppression. Higher vaccine doses or adjuvants (like Shingrix) partially overcome effects. Consult rheumatologists for titer checks.[1][3]
Patient Risks and Real-World Concerns
Patients report breakthrough infections (e.g., shingles despite Shingrix) and question annual boosters. Long-term data show no excess malignancy or mortality from impaired responses, but monitor for opportunists like varicella-zoster.[2][3]
[1]: Novartis Cosentyx Prescribing Information, https://www.cosentyx.com
[2]: American College of Rheumatology Guidelines on Vaccinations in Rheumatic Diseases, 2021
[3]: Lancet Rheumatology (JUVENTAS trial), 2022, https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(22)00123-4/fulltext
[4]: EULAR Recommendations for Vaccination in IBD/IBD-like Conditions, 2023
[5]: Rheumatology (Oxford) study on COVID seroresponse in IL-17 inhibitors, 2022
[6]: Annals of Rheumatic Diseases, COVID outcomes in secukinumab users, 2023