Table. Recommended timing of live vaccine administration for people receiving immunosuppressive therapies

• ≥4 weeks before starting treatment, or
• ≥3 months after treatment ends (with disease in remission and immune competence has been confirmed)

• ≥4 weeks before starting treatment, or
• >12 months after transplantation (immune competence has been confirmed)

• Hydroxychloroquine
• Sulfasalazine (and mesalazine)

• Leflunomide
• mTOR inhibitors (eg sirolimus, everolimus)

• ≥4 weeks before starting treatment, or
• ≥4 weeks after treatment ends

• Azathioprine (>3 mg/kg/day)^a
• 6-mercaptopurine (>1.5 mg/kg/day)^a
• Methotrexate (>25 mg/week)^a
• Mycophenolate
• Calcineurin inhibitors (eg cyclosporin, tacrolimus)
• Cyclophosphamide

• ≥4 weeks before starting treatment, or
• ≥3 months after treatment ends

• Anti-CGRP antibodies (such as fremanezumab, eptinezumab)
• Anti-RANK ligand antibodies (e.g. denosumab)
• Anti-IL-5 antibodies (e.g. mepolizumab, reslizumab)
• Anti-IgE antibodies (e.g. omalizumab)
• Complement inhibitors (e.g. eculizumab, ravulizumab)

• Anti-IL-1 antibodies (e.g. anakinra)
• Anti-IL-6 antibodies (e.g. tocilizumab)
• Anti-IL-17 antibodies (e.g. secukinumab)
• Anti-IL-23 antibodies (e.g. guselkumab)
• Integrin inhibitors (e.g. natalizumab, vedolizumab)
• TNF-alpha inhibitors (e.g. adalimumab, etanercept, infliximab)

• ≥4 weeks before starting treatment, or
• ≥4 weeks after treatment ends^b

• T cell inhibitors (eg abatacept, basiliximab)
• Agents targeting cellular markers (eg blinatumomab, daratumumab)

• ≥4 weeks before starting treatment, or
• ≥3 months after treatment ends

• ≥4 weeks before starting treatment, or
• ≥6 months after treatment ends (with confirmation of immune competence)

• ALK inhibitors (e.g. crizotinib, ceritinib, alectinib)
• CDK inhibitors (e.g. palbociclib, ribociclib)

• JAK inhibitors (e.g. tofacitinib, baricitinib, ruxolitinib)
• BCR-ABL tyrosine kinase inhibitors (e.g. imatinib, dasatinib)
• Bruton’s tyrosine inhibitors (e.g. ibrutinib, acalabrutinib)

• ≥4 weeks before starting treatment, or
• ≥4 weeks after treatment ends^b

Acronyms used: 

• ALK = anaplastic lymphoma kinase
• CDK = cyclin-dependent kinase
• CGRP = calcitonin gene-related peptide
• IgE = immunoglobulin E 
• IL = interleukin 
• JAK = Janus kinase
• mTOR = mammalian target of rapamycin 
• RANK = receptor activator of nuclear factor kappa B 
• TNF = tumour necrosis factor

Footnotes:

^a People taking azathioprine (≤3 mg/kg/day), 6-mercaptopurine (≤1.5 mg/kg/day), methotrexate (≤25 mg/week) can receive live vaccines on advice from a specialist and after a risk assessment. 
^b For people taking some biological or small molecule targeted therapies (such as JAK inhibitors), spacing times can be adjusted on advice from a specialist and after a risk assessment. Some live vaccines may be considered if vaccination is considered of great benefit (such as yellow fever vaccine for adult travellers) and the risk of a disease flare when patients are not taking immunosuppressive therapy is high.