Gastroenterology and hepatology
Immunosuppressants and biologics in IBD: indications and pre-treatment screening
What each IBD immunosuppressant and advanced therapy is for, the screen before starting (hepatitis B, TB, varicella, HIV, strongyloides, TPMT and NUDT15), reading the results with worked examples, vaccination, drug-specific checks for JAK inhibitors, S1P modulators and ciclosporin, and anti-TNF drug level interpretation.
Tier 1Medical sciences concept
Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Disease activity, induction and the choice of drug are in Inflammatory bowel disease. This note covers what each drug is for, the screen before it starts, and how to read the results.
- Every patient heading for a thiopurine, methotrexate or advanced therapy needs the same core screen: hepatitis B, hepatitis C, HIV, latent TB, varicella, vaccination history and, for some, strongyloides.
- Do the screen at diagnosis or at the first steroid course. Waiting until the day a biologic is needed delays treatment by weeks.
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Sources
- Therapeutic Guidelines: Gastrointestinal (eTG complete), inflammatory bowel diseaseAU/NZTherapeutic Guidelines Limited
- Crohn's & Colitis Australia, resources for health professionalsAU/NZCrohn's & Colitis Australia
- Australian Immunisation Handbook: vaccination for people who are immunocompromised; zoster; pneumococcal diseaseAU/NZAustralian Government Department of Health, Disability and Ageing, 2026 online edition
- Pharmaceutical Benefits Scheme: authority restrictions for biological and small-molecule therapies in Crohn's disease and ulcerative colitisAU/NZAustralian Government Department of Health, Disability and Ageing
- ECCO Guidelines on the Prevention, Diagnosis and Management of Infections in Inflammatory Bowel Disease (2025 update). J Crohns Colitis 2026;20(7):jjag071European Crohn's and Colitis Organisation, 2025 update, published 2026
- ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. J Crohns Colitis 2026European Crohn's and Colitis Organisation, 2026
- Feuerstein JD et al. American Gastroenterological Association Institute guideline on therapeutic drug monitoring in inflammatory bowel disease. Gastroenterology 2017;153:827-34American Gastroenterological Association, 2017
- Clinical Pharmacogenetics Implementation Consortium guideline for thiopurine dosing based on TPMT and NUDT15 genotypes: 2018 updateCPIC, 2018
- Ytterberg SR et al. Cardiovascular and cancer risk with tofacitinib in rheumatoid arthritis (ORAL Surveillance). N Engl J Med 2022;386:316-26New England Journal of Medicine, 2022
- Last updated
- 14 November 2026
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