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).

However, live vaccines have generally been contraindicated in patients who are severely immunocompromised as a result of taking DMARDs, because of concerns about possible vaccine-induced disease from uncontrolled viral replication.¹

While inactive vaccines are safe and immunocompromised patients should remain up-to-date with vaccinations such as influenza and pneumococcal, the vaccine effectiveness may be reduced as a result of biologic therapies.