Prior to Initiating Therapy
✓  Initial/baseline bloodwork such as complete blood counts, renal function, liver function

While on Therapy
✓ Yearly Renal (kidney) function test. Order yearly urinalysis

Prior to Initiating Therapy
✓  Initial/baseline bloodwork such as complete blood count, renal function, liver function

While on Therapy
✓  Routine bloodwork such as complete blood count, renal function, liver function every 3-6 months
✓  Yearly urinalysis
✓ Daily folic acid supplements (1mg /day and up 2 mg/ day if pregnant)

NOTE: More frequent lab monitoring may be necessary during first few months of therapy

Prior to Initiating Therapy
✓  Tuberculosis (TB) screening prior to initiating medication (e.g. QuantiFERON- TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray)
✓  Check Hepatitis B Immunity Status (preferably before starting therapy but can be done after starting therapy) and re/vaccinate if not immune
✓  Avoid live vaccines within 4 weeks of starting therapy and during therapy
✓  Initial/baseline bloodwork such as complete blood count, renal function, liver function

While on Therapy
✓  Annual TB risk assessment and screening if meeting criteria for high risk
✓ Avoid live vaccines
✓  Routine bloodwork such as complete blood count, renal function, liver function every3-6 months
✓ Consider measuring drug concentrations to ensure there is a therapeutic amount of drug in the system, especially when symptomatic. (This can be considered shorty after starting therapy)

Patient Traveling Soon?
They may be considered high-risk for TB if traveling to certain countries. Check if destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list

Prior to Initiating Therapy
✓  Enroll patient in TOUCH program
✓  Initial/baseline bloodwork such as complete blood count, renal function, liver function

While on Therapy
✓  Routine bloodwork such as complete blood counts, renal function, liver function every 3-6 months

Prior to Initiating Therapy
✓  Tuberculosis (TB) screening prior to initiating medication (e.g. QuantiFERON- TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray)
✓  Avoid live vaccines within 4 weeks of starting therapy
✓  Initial/baseline bloodwork such as complete blood count renal function, liver function

While on Therapy
✓  Annual TB risk assessment and screening if meeting criteria for high risk
✓  Avoid live vaccines
✓  Routine bloodwork such as complete blood count, renal function, liver function every 3-6 months (Skyrizi LFT check within 12 weeks of initiating)
✓  Consider measuring drug concentrations to ensure there is a therapeutic amount of drug in the system, especially when symptomatic

Patient Traveling Soon?
They may be considered high-risk for TB if traveling to certain countries. Check if destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list

Prior to Initiating Therapy
Consideration: Patients at high risk for tuberculosis (TB) may be screened, at your discretion
✓  Initial/baseline bloodwork such as complete blood count, renal function, liver function
✓  Avoid live vaccines within 4 weeks of starting therapy

While on Therapy
✓  Avoid live vaccines
✓  Routine bloodwork such as complete blood count, renal function, liver function every 3-6 months
✓  Consider measuring drug concentrations to ensure there is a therapeutic amount of drug in the system, especially when symptomatic

corticosteroids – budesonide

corticosteroids – prednisone

Entocort® EC
Uceris™

A-Methapred® Depo-Medrol® Medrol Dosepak® Solu-Medrol® Deltasone® Oraped® Prelone® Pediapred®

✓  Daily Calcium (1200-1500 mg) and Vitamin D supplements (1000-2000 IU)
✓  Recommend an ophthalmology exam to monitor for ocular side effects
✓  Consider a bone density exam*

* Generally, a bone density exam may be considered if patient has used oral corticosteroids lasting > 3 months, or if patient has used oral corticosteroids lasting 1 year within the past 2 years.

*Women 65 or older should receive a bone density for preventative screening every 2 years regardless of steroid exposure.

Prior to Initiating Therapy
✓  Review all medications, including herbal supplements
✓  Iitial/Baseline bloodwork such as complete blood count, renal function, liver function, potassium, cholesterol, and magnesium levels.

While on Therapy
✓  Avoid grapefruit juice
✓  Routine monitoring of drug concentrations and bloodwork such as complete blood count, renal function, liver function, potassium, cholesterol, and magnesium levels every 3-6 months
✓  Recommend consistency of taking medication, either always with food or always without food

NOTE: More frequent lab monitoring may be necessary during first few months of therapy

Prior to Initiating Therapy
✓  Initial/baseline bloodwork such as complete blood count, renal function, liver function

While on Therapy
✓  Routine bloodwork such as complete blood count, renal function, liver function every 3-6 months
✓  Daily folic acid supplements (1 mg/day)

NOTE: More frequent lab monitoring may be necessary during first few months of therapy

Patient Considering Pregnancy?
It is recommended to stop this therapy 3-6 months prior to getting pregnant. Remind patient to include you in discussions when family-planning so you can support them in having a
healthy pregnancy while keeping their IBD under control.

Prior to Initiating Therapy
✓  Review all medications, including herbal supplements, with care team prior to starting Order initial/baseline bloodwork such as complete blood count, renal function, liver function, potassium, cholesterol, and magnesium levels.

While on Therapy
✓  Avoid grapefruit juice
✓  Recommend consistency of taking medication, either always with food or always without food
✓  Routine monitoring of drug concentrations Order routine bloodwork such as complete blood count, renal function, liver function, potassium, cholesterol, and magnesium levels every 3-6 months

NOTE: More frequent lab monitoring may be necessary during first few months of therapy

Prior to Initiating Therapy
✓  Thiopurine methyltransferase (TPMT) enzyme blood test to ensure a safe start to the medication. Results will impact starting dose.
✓  Initial/baseline bloodwork such as complete blood count, renal function, liver function

While on Therapy
✓  Routine bloodwork such as complete blood count, renal function, liver function every 3-6 months
✓  Consider measuring drug concentrations to ensure there is a therapeutic amount of drug in the system (Thiopurine Metabolites)

NOTE: More frequent lab monitoring may be necessary during first few months of therapy

Prior to Initiating Therapy
✓  Tuberculosis (TB) screening must be completed prior to initiating medication (e.g. QuantiFERON- TB Gold or PPD. If high risk or indeterminate results from QuantiFERON-TB Gold or PPD: Chest X-ray)
✓  Avoid live vaccines within 4 weeks of starting therapy and during therapy
✓  Initial/baseline bloodwork such as complete blood count, renal function, liver function and consider fasting lipid profile
*The Inactive Herpes Zoster vaccine (Shingrix) should be considered, especially if patient is above the age of 50 but can be considered in patients 19 years or older.

While on Therapy
✓  Fasting lipid profile, recommended 4-12 weeks after starting therapy
✓  Annual TB risk assessment and screening if you meet criteria for high risk
✓  Routine bloodwork such as complete blood count, renal function, liver function every 3-6 months

NOTE: More frequent lab monitoring may be necessary during first few months of therapy

Patient Traveling Soon?
They may be considered high-risk for TB if traveling to certain countries. Check if destination is high-risk for TB here: https://wwwnc.cdc.gov/travel/destinations/list

Patient Considering Pregnancy?
You may need to adjust your patient’s IBD therapy plan, so
please remind your patient to include you in discussions when family- planning

Prior to Initiating Therapy
✓  Electrocardiogram (EKG) to screen for preexisting conduction abnormalities
✓  Monitor blood pressure
✓  Review all medications to ensure they don’t impact
heart rate
✓  Recommend an ophthalmologist visit if patient has diabetes, or is diagnosed with inflammation or swelling inside the eye
✓  Initial/baseline bloodwork such as complete blood count, renal function, liver function

While on Therapy

✓  Routine bloodwork such as complete blood count, renal function, liver function every 3-6 months

Initial Dosing Schedule

NOTE: More frequent lab monitoring may be necessary during first few months of therapy

Patient Considering Pregnancy?
It is recommended to stop this therapy 3-6 months prior to getting pregnant. Please remind your patient to include you in discussions when family-planning so you can support them in having a healthy pregnancy while keeping their IBD under control.

Live

This vaccine should not be administered when taking certain IBD medications, such as biologics or immunosuppress ants including corticosteroids

The varicella vaccine is the best way to protect patients from getting the chicken pox. People 13 years of age and older who have never had chickenpox or received the chickenpox vaccine should get two doses, at least 28 days apart. The chickenpox vaccine was added to the childhood immunization schedule in 1995, so most people born prior to 1995 had a higher likelihood of getting chickenpox and getting immunity that way.

Note that even if your patient had chickenpox in the past, their immunity may have weakened over time and the titers can be checked. If low titers patient may be recommended to receive 2 doses of the chickenpox vaccine.

Patients on low-dose immunosuppression may consider the chickenpox vaccine (e.g., ≤ 20 mg/day prednisone,≤0.4 mg/kg/week MTX, ≤ 1.5 mg/kg/day 6-MP, ≤
3 mg/kg/day azathioprine.)

The flu shot (non-live) and not the nasal mist (live vaccine) is recommended

If possible, members of the household should also opt for the flu shot and avoid the nasal mist.

Live

This vaccine should not be administered when taking certain IBD medications, such as biologics or immunosuppress ants including corticosteroids

The MMR vaccine protects patients against Measles, Mumps, and
Rubella and is routinely completed by 6 years old. This vaccine, particularly its immunity to Rubella, is especially important for women of child-bearing age.

Patients on low-dose immunosuppression may consider the chickenpox vaccine (e.g., ≤ 20 mg/day prednisone,≤0.4 mg/kg/week MTX, ≤ 1.5 mg/kg/day 6-MP, ≤ 3 mg/kg/day azathioprine.)

Meningococcal A, C, W, Y (MenACWY) is typically given at 11-12 years, and 16 years of age.

This vaccine is recommended for first-year college students who live in residential housing and military recruits.

PCV13 (Prevnar 13®) PCV15 (Prevnar15®), PCV20 (Prevnar20® )is a routine vaccination for those with chronic medical conditions, like IBD, that can protect patients against pneumonia. Prevnar 7 ® was a routine vaccination for infants up until February 2010, when the other Prevnar vaccines replaced it.

Studies show that patients with IBD, regardless of age, would benefit from this one-time vaccination. PPSV23 can be given at least 8 weeks from PCV13 and PCV15. PPSV23 is not recommended if the patient received PCV20.