Drug Interactions between cholera vaccine, live and rozanolixizumab

GENERALLY AVOID: The safety, immunogenicity, and efficacy of live, attenuated viral or bacterial vaccines during treatment with a neonatal Fc receptor (FcRn) blocker like efgartigimod alfa or rozanolixizumab have not been evaluated. FcRn blockers can cause a transient reduction in IgG levels. In addition, efgartigimod alfa may decrease white blood cell, lymphocyte, and neutrophil counts. Administration of live, attenuated viral or bacterial vaccines during treatment with FcRn blockers may theoretically increase the risk of disseminated infection due to enhanced replication of vaccine virus or bacteria in the presence of diminished immune competence. Increased adverse reactions and decreased or suboptimal immunologic response to vaccines may also occur.

MANAGEMENT: Immunization with live, attenuated viral or bacterial vaccines is generally not recommended during treatment with FcRn blockers. The need to administer age-appropriate vaccines according to immunization guidelines should be assessed prior to initiation of a new treatment cycle with FcRn blockers. It is advisable to complete recommended vaccinations before starting FcRn blockers to avoid potential effects of the medication on immunologic response to vaccines. According to some authorities, this should be completed at least 4 weeks prior to the initiation of treatment with rozanolixizumab or efgartigimod alfa. However, other authorities suggest that patients currently being treated with efgartigimod alfa who require vaccination with live or live-attenuated vaccines may receive these vaccines at least 4 weeks before treatment and at least 2 weeks after the last dose of efgartigimod alfa. Individual product labeling should be consulted for further guidance.