Live vaccinations and immunocompromised patients

For many years, immunosuppression to treat autoimmune inflammatory rheumatic diseases has comprised corticosteroids and conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) such as methotrexate and sulfasalazine.

Treatment of these conditions has been revolutionised by the introduction of biologic DMARDs (bDMARDs) such as etanercept or rituximab, which target pro-inflammatory cytokines or cell types, respectively, and more recently, oral targeted synthetic DMARDs (tsDMARDs) such as tofacitinib and baricitinib (see table 1).