Testing, Logistics, and Monitoring

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PRE-TESTING AND VACCINATION

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 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.

METHOD OF ADMINISTRATION

IV infusion
SC injection

LOCATION
 

Infusion centre
Home

DOSING

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.

TIME REQUIRED

3-4 hrs
Those who do not experience a reaction can be infused <2 hrs

SC Injection – 5 min

ROUTINE MONITORING

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

           
Edit Content

PRE-TESTING AND VACCINATION

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 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.

METHOD OF ADMINISTRATION

SC injection

LOCATION
 

Home
Injection support can be arranged.

DOSING

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.

TIME REQUIRED

<15 min

ROUTINE MONITORING

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

           
Edit Content

PRE-TESTING AND VACCINATION

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 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.

METHOD OF ADMINISTRATION

IV infusion x 1 then SC injection

LOCATION

Infusion centre
Home

DOSING

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.

TIME REQUIRED

1–2 hrs for initial IV infusion
SC injection <15 min

ROUTINE MONITORING

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

           
Edit Content

PRE-TESTING AND VACCINATION

For more detailed information on vaccinations, please see the CANIBD Vaccination Guide

TB screening should be considered.

METHOD OF ADMINISTRATION

IV infusion or SC injection

LOCATION

Infusion centre or Home

DOSING

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.

TIME REQUIRED

1–2 hrs for infusion

< 5 min SC injection

ROUTINE MONITORING

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

           
Edit Content

PRE-TESTING AND VACCINATION

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.

METHOD OF ADMINISTRATION

SC injection

LOCATION

Home

DOSING

Induction/loading: wk 0, two 100mg injections, wk 2, one 100 mg injection,

then maintenance, one 100 mg injection every 4 wks*

TIME REQUIRED

<15 min

ROUTINE MONITORING

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.

           
Edit Content

PRE-TESTING AND VACCINATION

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.

METHOD OF ADMINISTRATION

Oral

LOCATION

Home

DOSING

Induction/loading: 10 mg twice/day for 8 wks,

then maintenance 5 mg twice daily

TIME REQUIRED

5 min

ROUTINE MONITORING

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.
           
Edit Content

PRE-TESTING AND VACCINATION

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

Recommend receiving live vaccines prior to starting therapy

METHOD OF ADMINISTRATION

Oral

LOCATION

Home

DOSING

Induction: 45mg once daily for 12 wks.
then maintenance 15mg or 30mg once daily.

TIME REQUIRED

5 mins 

ROUTINE MONITORING

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

           
Edit Content

PRE-TESTING AND VACCINATION

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

METHOD OF ADMINISTRATION

Oral

LOCATION

Home

DOSING

Induction/loading:
Days 1–4: 0.23 mg
Day 5–7: 0.46 mg

Day 8 / Maintenance: 0.92 mg

TIME REQUIRED

5 minutes 

ROUTINE MONITORING

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

           
Edit Content

PRE-TESTING AND VACCINATION

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

METHOD OF ADMINISTRATION

Infusion/injection

LOCATION

Infusion centre
Home

DOSING

Induction:
300 mg IV wks 0, 4 and 8,

then maintenance 200 mg SC (2 consecutive injections of 100 mg each) at wk 12 and every 4 wks thereafter

TIME REQUIRED

Minimum 30-min infusion

Self-injection 5 min

ROUTINE MONITORING

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.
           
Edit Content

PRE-TESTING AND VACCINATION

For more detailed information on vaccinations, please see the CANIBD Vaccination Guide

Baseline ECG. In patients with pre-existing conditions, advice from a cardiologist should be sought.

Blood work (baseline CBC, renal and liver function)
Opthalmic assessment in patients with a history of diabetes, uveitis or retinal disease.

Ensure all immunizations are current. Refer to CANIBD Vaccination Guidelines for further information14

Contraindications: Last 6 months myocardial infarction, unstable angina, pectoris, stroke, transient ischemic attack, decompensated heart failure, Mobitz type II second-degree or third-degree atrioventricular block, sick sinus syndrome, or sino-atrial block, unless the patient has a functioning pacemake,
immunocompromised, severe active infections, active malignancies

METHOD OF ADMINISTRATION

Oral

LOCATION

Home

DOSING

2 mg tablet once daily

Due to risk of transient decreases in heart rate, first dose cardiac monitoring recommended.

Hourly pulse and blood pressure for 4-hr period. ECG prior to and at the end of this 4-hr period is recommended.

Please refer to product monograph for additional information.

TIME REQUIRED

5 min

ROUTINE MONITORING

Baseline bloodwork: Liver enzymes, ECG and ophthalmic evaluation. Follow up blood work as clinically indicated.

Blood pressure should be monitored during treatment and managed appropriately.

Patients with a history of diabetes mellitus, uveitis or retinal disease undergo follow up ophthalmologic evaluations while receiving therapy.

           

*Dose and frequency adjustments can be made at the discretion of the practitioner.

†Frequency of infusions can be adjusted at the discretion of the practitioner.

TB: Tuberculosis, CBC: complete blood count, ­HBV: hepatitis B virus, HAV: hepatitis A virus, HPV: Human papillomavirus, Tdap: tetanus, diphtheria, and pertussis, IV: intravenous, SC: subcutaneous, wk: week, hrs: hours, min: minutes.