Synopsis
Select and sequence advanced IBD therapies by phenotype, efficacy, safety and patient preference, with complete infection screening, early objective response assessment and class-specific toxicity management.
- Advanced IBD therapy includes anti-TNF, anti-integrin, interleukin-targeted biologics, Janus kinase inhibitors and sphingosine-1-phosphate modulators; licensed and NICE-funded choices change frequently.
- Choose from disease, location, fistulising or extra-intestinal phenotype, previous exposure, required speed, pregnancy plans, comorbidity, route, adherence and patient preference rather than a fixed universal ladder.
- Before treatment, confirm objective inflammation and screen tuberculosis, hepatitis and other relevant infection, vaccination status, malignancy history and class-specific cardiovascular or thrombotic risk.
Key red flags
Never start or continue an advanced immune therapy through uncontrolled sepsis, untreated active tuberculosis, major opportunistic infection or an undrained Crohn abscess.
Investigation priorities
Confirm that active inflammation justifies escalation and provide a response baseline.
Management branches
Moderate to severe objective IBD activity needs advanced steroid-sparing therapy.
- Confirm diagnosis, inflammatory target, luminal versus fistulising phenotype, previous drug response, need for speed and whether surgery or drainage better addresses structural disease.
- Screen infection, vaccination, malignancy, cardiovascular and thrombosis risk, organ function, pregnancy plans and medicine interactions before narrowing the class choice.
Key medicines
InfliximabWeight-based intravenous induction and maintenance using the licensed specialist protocol.
VedolizumabIntravenous or subcutaneous induction and maintenance according to the licensed formulation.