Remicade®/Janssen/BioAdvance® (CD 2003, UC 2006)
Inflectra®/Pfizer/PfizerFlex (2014)
Renflexis®/Organon/Harmony by Organon™ (2018)
Avsola®/Amgen/Enliven Services (2020)
Remsima®/Celltrion/Celltrion Connect™ (2024)
Crohn’s disease
Ulcerative colitis
Monoclonal antibody
Tumour necrosis factor (TNF) blocking agent
IBD causes the immune system to produce an excess amount of TNFα, which causes inflammation. Anti-TNFα is a protein that works to bind TNFα and block inflammation.
Humira®/AbbVie/AbbVie Care (2004)
Abrilada®/Pfizer/Pfizer Flex (2022)
Amgevita®/Amgen/Enliven Services (2021)
Hadlima®/Organon/Harmony by Organon™ (2021)
Hulio®/Biocon/My Biocon Biologics (2022)
Idacio®/Fresenius Kabi/KabiCare® (2021)
Simlandi™/JAMP Pharma/JAMP Care (2022)
Yuflyma®/Celltrion/Celltrion Connect™ (2022)
Crohn’s disease
Ulcerative colitis
Monoclonal antibody
Tumour necrosis factor (TNF) blocking agent
IBD causes the immune system to produce an excess amount of TNFα, which causes inflammation. Anti-TNFα is a protein that works to bind TNFα and block inflammation.
Stelara®/Janssen/BioAdvance® (CD 2017, UC 2020)
Wezlana™/Amgen/EnlivenServices (2024)
Crohn’s disease
Ulcerative colitis
Monoclonal antibody interleukin (IL)-12/23 inhibitor
Targets an overactive immune system by blocking two receptors called IL-12 and IL-23. By blocking these receptors, cells are slowed down, which reduces inflammation.
Crohn’s disease
Ulcerative colitis
Monoclonal antibody integrin receptor blocker
Simponi®/Janssen/BioAdvance® (2013)
Ulcerative colitis
Monoclonal antibody tumour necrosis factor (TNF) blocking agent
IBD causes the immune system to produce an excess amount of TNFα, which causes inflammation. Anti-TNFα is a protein that works to bind TNFα and block inflammation.
Xeljanz®/Pfizer/PfizerFlex™ (2018)
Ulcerative colitis
Janus kinase (JAK) inhibitor
JAKs are intracellular enzymes/proteins that activate the body’s immune response, causing gut inflammation. JAK inhibitors block this pathway. Works by attaching to the JAK enzyme to lower its activity and to decrease inflammation in the body.
Rinvoq/Abbvie/Abbvie Care (2023)
Crohn’s disease
Ulcerative colitis
JAK Inhibitor
JAKs are intracellular enzymes that activate the body’s immune response causing inflammation. JAK inhibitors block this pathway. Works by attaching to the JAK enzyme to lower its activity and to decrease inflammation in the body.
Zeposia®/Bristol Myers Squibb/Bristol Myers Squibb Access Support® (2022)
Ulcerative colitis
Sphingosine 1 phosphate (S1P) modulator
Binds with high affinity to S1P receptor 1 and reduces the capacity of lymphocytes to migrate from lymphoid tissue, reducing the number of circulating lymphocytes in peripheral blood and lymphocyte migration into the intestines. Decreases the cells involved in immune response.
Ulcerative colitis
Interleukin-23 (IL-23) p 19 antagonist
Humanized immunoglobulin G4 (IgG4) monoclonal antibody that binds with high affinity and specificity to the p19 subunit of human IL-23 cytokine and inhibits its interaction with the IL-23 receptor.
Ulcerative colitis
Selective Sphingosine 1-phosphate (S1P) receptor modulator
Binds with high affinity to S1P receptor 1 and reduces the capacity of lymphocytes to migrate from lymphoid tissue, reducing the number of circulating lymphocytes in peripheral blood and lymphocyte migration into the intestines. Decreases the cells involved in immune response.
Chest X-ray
TB skin test
Blood work (baseline CBC, renal and liver function, HBV)
Ensure all immunizations are current.
Wait at least four weeks to start following administration of live vaccination.
Pneumococcal vaccination recommended for adult patients.
Recommend vaccinations: HAV, HBV, HPV, and Tdap
Refer to CANIBD Vaccination Guidelines for further information.14
Use with caution in patients with chronic or recurrent infection.
IV infusion
SC injection
Infusion centre
Home
Adult Dosing:
Weight-based dosing. Standard dose is 5 mg/kg. Dose escalation to 10mg/kg may be considered. Induction: wk 0, wk 2, wk 6, then maintenance every 8 wks*
Patients who experience a disease flare or are non-responsive, a shorter infusion interval may be considered.
Infliximab SC (Remsima) – For patients who have completed an induction.
IV infliximab: Maintenance dosing regimen of 120 mg (given as one subcutaneous injection) once every 2 wks, starting 4 wks following completion of an induction regimen.
For patients already receiving intravenous infliximab maintenance therapy: Maintenance therapy with IV infliximab and who are switching to SC maintenance therapy, the first dose of may be administered 8 wks after the last infusion.
Paediatric Dosing:
(≥ 9 years of age) with moderately to severely active Crohn’s disease:
5 mg/kg given as an induction regimen at 0, 2 and 6 wks followed by a maintenance regimen of 5 mg/kg every 8 wks.
The safety and efficacy of Remicade® has not been established in paediatric patients with Crohn’s disease <9 years of age.
3-4 hrs
Those who do not experience a reaction can be infused <2 hrs
SC Injection – 5 min
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
May consider therapeutic drug monitoring (TDM) if available
Screening for osteoporosis with bone mineral density testing periodically after diagnosis
Chest X-ray
TB skin test
Blood work (baseline CBC, renal and liver function, HBV)
Ensure all immunizations are current.
Wait at least four weeks to start following administration of live vaccination.
Pneumococcal vaccination recommended for adult patients.
Recommend vaccinations: HAV, HBV, HPV, and Tdap
Refer to CANIBD Vaccination Guidelines for further information.14
Use with caution in patients with chronic or recurrent infection.
SC injection
Home
Injection support can be arranged.
Adult Dosing:
Induction: 160 mg, 80 mg, 40 mg,
wk 0, wk 2, wk 4,
then maintenance 40 mg every 2 wks*
Patients who experience a disease flare or are non-responsive, dose escalation may be considered.
Paediatric Dosing:
13 to 17 years of age
≥ 40 kg: 160 mg at Wk 0, 80 mg at Wk 2. Maintenance dose regimen is 20 mg every other week beginning at Wk 4.
For paediatric patients who experience a disease flare or non-response, dose escalation to 40 mg every other week may be considered.
<15 min
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
May consider therapeutic drug monitoring (TDM) if available
Screening for osteoporosis with bone mineral density testing periodically after diagnosis
Chest X-ray
TB skin test
Blood work (baseline CBC, renal and liver function, HBV)
Ensure all immunizations are current.
Wait at least four weeks to start following administration of live vaccination.
Pneumococcal vaccination recommended for adult patients.
Recommend vaccinations: HAV, HBV, HPV, and Tdap
Refer to CANIBD Vaccination Guidelines for further information.14
Use with caution in patients with chronic or recurrent infection.
IV infusion x 1 then SC injection
Infusion centre
Home
Induction: weight based at 6mg/kg
up to 55kg- 260mg
>55kg-85kg- 390mg
>85 kg- 520mg
then maintenance 90 mg SC every 8 wks*
Following the first SC dose at 8 wks, those with low inflammatory burden may receive 90mg SC every 12 wks at the discretion of the HCP.
Patients who experience a disease flare or are non-responsive, a shorter infusion interval (q 4 wks) may be considered.
1–2 hrs for initial IV infusion
SC injection <15 min
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
May consider therapeutic drug monitoring (TDM) if available
Screening for osteoporosis with bone mineral density testing periodically after diagnosis
TB screening should be considered.
IV infusion or SC injection
Infusion centre or Home
Induction: 300 mg IV wk 0, wk 2, wk 6,
then maintenance 300 mg every 8 wks OR
following at least 2 IV infusions, 108 mg SC every 2 wks†
Patients who experience a disease flare or are non-responsive, a shorter infusion interval (q 4 wks) may be considered.
1–2 hrs for infusion
< 5 min SC injection
Patients should be monitored for any new onset or worsening of neurological signs and symptoms
Liver enzymes – transaminases and bilirubin.
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
May consider therapeutic drug monitoring (TDM) if available
Screening for osteoporosis with bone mineral density testing periodically after diagnosis
For more detailed information on vaccinations, please see the CANIBD Vaccination Guide
Chest X-ray
TB skin test
Blood work (baseline CBC, renal and liver function, HBV)
Ensure all immunizations are current.
Wait at least 4 weeks to start following administration of live vaccination.
Pneumococcal vaccination recommended for adult patients.
Recommend vaccinations HAV, HBV, HPV, and Tdap.
Refer to CANIBD Vaccination Guidelines for further information.14
Use with caution in patients with chronic or recurrent infection.
SC injection
Home
Induction/loading: wk 0, two 100mg injections, wk 2, one 100 mg injection,
then maintenance, one 100 mg injection every 4 wks*
<15 min
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended.
May consider therapeutic drug monitoring (TDM) if available.
Screening for osteoporosis with bone mineral density testing periodically after diagnosis.
For more detailed information on vaccinations, please see the CANIBD Vaccination Guide
TB skin test
Blood work (baseline CBC, liver enzymes, lipids, CK, renal function, hepatitis B serology)
Shingrix® zoster vaccination
Ensure all immunizations are current. Refer to CANIBD Vaccination Guidelines for further information.14
Recommend receiving live vaccines prior to starting therapy.
Oral
Home
Induction/loading: 10 mg twice/day for 8 wks,
then maintenance 5 mg twice daily but 10 mg BID may also be used in some patients. Lowest possible dose should be used.
5 min
Lipids at baseline, 4–8 wks after initiation and every 6 mos thereafter.
Liver enzymes and renal function prior to initiation;
CBC with differential at baseline, approx. 4–8 wks after initiation, every 3 mos thereafter.
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
Screening for osteoporosis with bone mineral density testing periodically after diagnosis
TB skin test
Blood work (baseline CBC, liver enzymes, lipids, CK, renal function, Hepatitis B serology)
Shingrix® zoster vaccination
Recommend receiving live vaccines prior to starting therapy
Oral
Home
Induction: 45mg once daily for 12 wks.
then maintenance 15mg or 30mg once daily.
5 mins
Baseline blood work – CBC
Liver enzymes, lipids, CK, renal function and Hepatitis B serology
Blood work q 3 months
Including CBC, liver enzymes, lipids, CK, and renal function
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
Screening for osteoporosis with bone mineral density testing periodically after diagnosis
For more detailed information on vaccinations, please see the CANIBD Vaccination Guide
Baseline ECG
Ensure all immunizations are up to date. Refer to CANIBD Vaccination Guidelines for further information.14
Blood work (baseline LFTs and CBC)
Contraindications:
MAO inhibitors
Last 6 months: myocardial infarction, unstable angina, stroke, TIA, decompensated heart failure, 2nd-degree AV block type II or 3rd-degree AV block, sick sinus syndrome or sinoatrial block unless patient has a pacemaker, pregnancy, severe infection, or active malignancies
Oral
Home
Induction/loading:
Days 1–4: 0.23 mg
Day 5–7: 0.46 mg
Day 8 / Maintenance: 0.92 mg
5 mins
Before treatment initiation: Baseline ECG, LFTs, CBC, VZV, negative pregnancy test
Only for patients at risk: Ophthalmic evaluation, consult cardiologist, and 6-hr first dose observation
Patients should be monitored for any new onset of neurological or visual signs and symptoms and onset bradycardia.
LFTs and CBC
For more detailed information on vaccinations, please see the CANIBD Vaccination Guide
TB skin test, blood work (baseline CBC, liver enzymes, lipids, CK, renal function, Hepatitis B serology)
Ensure all immunizations are current. Refer to CANIBD Vaccination Guidelines for further information.14
Infusion centre
Home
Induction: 300 mg IV wks 0, 4 and 8,
Evaluate patients after 12-week induction dosing and if there is adequate response transition to maintenance dosing.
If patients do not have adequate therapeutic response at week 12 after induction dosing, consider extended induction dosing by administering 300 mg IV at weeks 12, 16, and 20.
Maintenance:
200 mg SC (2 consecutive injections of 100 mg each) at wk 12 and every 4 wks thereafter.
Minimum 30-min infusion
Self-injection 5 min
Evaluate liver enzymes and bilirubin at baseline and every 1–4 mos during induction (including induction period, if applicable) and thereafter according to standard practice.
Annual cervical cancer screening – pap test
Annual skin exam – skin malignancies
Influenza vaccine recommended
Screening for osteoporosis with bone mineral density testing periodically after diagnosis