Advanced therapies for IBD

Modern options given by injection or as tablets, chosen to suit each patient

• Injections
• Infusions (drips)
• Tablets

What do we mean by advanced therapies?

Definition

Medicines that target specific pathways of inflammation. They are used for moderate to severe disease, or when conventional treatments are not enough.

They include two groups: biologic treatments given by injection or infusion, and small molecules taken as tablets.

Two main groups

Two groups

• Biologic treatments — large proteins given by injection under the skin or by infusion into a vein
• Small molecules — tablets taken by mouth that block certain signals in immune cells to calm the inflammation

No one type is best for everyone; your doctor chooses between them based on your condition and your preferences.

Types of small molecules

Modern tablets

• JAK inhibitors — block inflammation signals inside immune cells — for example: tofacitinib, upadacitinib, filgotinib
• Sphingosine-1-phosphate (S1P) receptor modulators — keep some immune cells in the lymph nodes so they do not reach the bowel — for example: ozanimod, etrasimod
• Use by disease type — upadacitinib is used in Crohn's disease and ulcerative colitis; the others are currently used in ulcerative colitis only. JAK inhibitors work relatively quickly

How do we choose the right treatment?

Choosing

• The type, location and severity of the disease
• Previous treatments and how you responded to them
• Age and other conditions — such as heart disease, blood clots or repeated infections
• Your preferences and circumstances — injections or tablets, dosing schedule, and plans for pregnancy

The decision is shared between you and your doctor after weighing up the benefits and risks.

Safety and follow-up

Safety

• Tests before starting — tuberculosis (TB), viral hepatitis, and a review of vaccinations
• Regular blood tests — such as blood count, liver function and blood fats (lipids), depending on the treatment
• Preventing shingles — the shingles vaccine (a non-live vaccine) may be recommended before some modern tablets
• Heart and eye assessment for some medicines — depending on the treatment and your risk factors

Plan pregnancy with your doctor

Very important

The modern tablets are not used during pregnancy or breastfeeding. Effective contraception is needed while taking them, and they must be stopped a period of time before pregnancy, as set by your doctor. Most biologic treatments, however, can be continued during pregnancy and breastfeeding.

Discuss your plan well before pregnancy, and do not stop your treatment on your own.

Advanced therapies: the summary

Key messages

• They include biologic treatments and small molecules
• They are used for moderate to severe disease
• Treatment is chosen after a full assessment and a shared decision
• Tests before starting and regular follow-up are essential
• Plan pregnancy with your doctor before it happens

Contact the clinic if you have:

• A fever or symptoms of infection
• Blurred vision
• Symptoms coming back
• A painful rash in a band (belt) shape
• A pregnancy, or plans for one
• A delayed dose or run out of medicine

If you have chest pain, difficulty breathing or sudden swelling of the leg, go straight to the nearest emergency department.