Vaccination Guide for
Immunosuppressed Patients with IBD
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.
IV Infusion
Infusion centre
Weight-based dosing. Standard dose is 5 mg/kg.
Induction: wk 0, wk 2, wk 6, then maintenance every 8 wks*
Pediatric 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 weeks followed by a maintenance regimen of 5 mg/kg every 8 weeks.
The safety and efficacy of Remicade® has not been established in pediatric patients with Crohn’s disease <9 years of age.
3-4 hrs
Those who do not experience a reaction can be infused <2 hrs
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.10
Use with caution in patients with chronic or recurrent infection.
SC injection
Home
Infusion centre is also available
Induction:
160 mg, 80 mg,
40 mg, wk 0, wk 2, wk 4,
then maintenance
40 mg every 2 wks*
Pediatric Dosing:
13 to 17 years of age
≥ 40 kg: 160 mg at Week 0, 80 mg at Week 2. Maintenance dose regimen is 20 mg every other week beginning at Week 4.
For pediatric 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.10
Use with caution in patients with chronic or recurrent infection.
IV infusion x 1 then SC injection
Infusion centre
Home
Induction:
300 mg IV x 1 infusion,
then maintenance 90 mg SC every 8 wks*
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 and SC injection
Infusion centre
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†
1–2 hrs
Patients should be monitored for any new onset or worsening of neurological signs and symptoms
Liver enzymes – transaminases and bilirubin.
IV infusion x 1 then on-body (SC) injector (OBI) with pre-filled cartridge
Infusion centre
Home
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
Minimum 1 hr infusion
OBI injection <15 min
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.
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
Oral
Home
Induction:
45mg once daily for 12 weeks
then maintenance 15mg or 30mg once daily
5 minutes
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
*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.