Advanced Therapies in Crohn's Disease

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.10

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.10

Use with caution in patients with chronic or recurrent infection.

METHOD OF ADMINISTRATION

SC injection

LOCATION
 

Home
Infusion centre is also available

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.10

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
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.10

Use with caution in patients with chronic or recurrent infection.

Liver tests as per routine patient management prior to initiating therapy.

METHOD OF ADMINISTRATION

IV infusion x 1 then on-body (SC) injector (OBI) with pre-filled cartridge

LOCATION
 

Infusion centre
Home

DOSING

Induction:
600 mg IV at wk 0, wk 4 and wk 8,

then 360 mg subcutaneous (OBI) at wk 12 and every 8 wks thereafter

TIME REQUIRED

Minimum 1 hr infusion

OBI injection <15 min

ROUTINE MONITORING

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
Liver enzymes as part of your routine blood work.

           
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 
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

May consider therapeutic drug monitoring (TDM) if available

Screening for osteoporosis with bone mineral density testing periodically after diagnosis

           

*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.

This tool is intended for Canadian Healthcare Professionals. Copyright © 2024 CANIBD Canadian IBD Nurses.

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CANIBD and Crohn's and Colitis Canada do not accept any responsibility or liability for the accuracy, content, completeness, legality, or reliability of the information contained in this Service. The content is not intended to diagnose, treat, cure or prevent disease. Content was developed in 2024 and is provided for informational purposes only.