Treatment regimens for patients with inflammatory bowel disease (IBD) have evolved dramatically over the past 10 years and continue to change with the advent of new medications. Treatment for IBD generally involves induction therapy followed by maintenance therapy, with the primary goal of achieving sustained clinical remission. Maintenance therapy for IBD, especially Crohn’s disease (CD), usually requires immunosuppressive therapy, including immunomodulators (eg, 6-mercaptopurine, azathioprine, or methotrexate), biologic therapy (eg, infliximab [Remicade, Janssen Biotech], adalimumab [Humira, Abbott], certolizumab pegol [Cimzia, UCB], or natalizumab [Tysabri, Biogen Idec]), or the combination of immunomodulators and biologic agents.
Clinicians have become increasingly aware of the risk of infection associated with these therapies, including disseminated zoster, pneumococcal sepsis, and acute hepatitis B virus infection in the setting of immunosuppressive therapy.1
Preventative vaccinations are available to protect against several of these infections. Numerous papers recommend routine vaccination; in fact, the Advisory Committee on Immunization Practices (ACIP) has set forth guidelines on vaccinations in patients with altered immunocompetence, including those on immunosuppression.11
Furthermore, guidelines based on expert opinion were published in 2004 by Sands and colleagues.13
In general, adults with IBD should be advised to adhere to standard recommended immunization schedules, but they should avoid live vaccines while on immunosuppressive therapy ().13
Available Vaccines and Associated Recommendations in Inflammatory Bowel Disease Patients on Immunosuppression
As awareness increases regarding the risk of vaccine-preventable infections in IBD patients who are on immunosuppressive therapy, an increasing number of studies have sought to evaluate the safety profiles and immunologic responses to various vaccines in this special population. The aim of this article is to review current evidence and provide a general approach to vaccination of patients with IBD who are on immunosuppressive medication.