What you need to know
Interactive IBD Drugs Cheat Sheet
This section reflects ECCO guidance and common clinical practice adopted with permission from Dr B Gros. Always confirm specifics with local guidelines. This summary is not a replacement for the comprehensive ECCO/BSG guidelines.
General ECCO‑Based Recommendations & Monitoring
ECCO guidelines emphasize baseline and ongoing checks before and during advanced therapy:
- Screen for infections: TB (IGRA or skin test + CXR), hepatitis B/C, HIV, varicella (± EBV if relevant).
- Update vaccinations: Influenza, pneumococcal, COVID‑19, and others before immunosuppression.
- Regular labs: FBC, LFT, renal function at set intervals.
- Match therapy to disease severity/location and your patient’s comorbidities.
- Use ECCO algorithms for step‑up or top‑down decisions.
5‑ASA (Mesalazine) Agents
- Induction Dose: ≥ 2 g/day up to 4.8 g/day
- Maintenance Dose: ≥ 2 g/day
- Route: Oral or topical
- Monitoring: Renal function checks
- ECCO Note: Best for mild–moderate UC; topical for left‑sided disease.
Thiopurines (Azathioprine, Mercaptopurine)
- Induction: Not for rapid induction
- Azathioprine Maintenance: 1.5–2.5 mg/kg/day
- Mercaptopurine Maintenance: 0.75–1.5 mg/kg/day
- Monitoring: FBC, LFT; TPMT testing first
- ECCO Note: Watch for myelotoxicity, especially with combination therapy.
Methotrexate
- Induction: 25 mg IM weekly (rarely alone for rapid induction)
- Maintenance: 15 mg IM weekly
- Monitoring: CBC, LFT, renal function
- Folic Acid (UK): 5 mg once weekly, on a different day
- ECCO Note: Supplement folate; monitor for liver fibrosis.
Anti‑TNF Agents (Infliximab, Adalimumab, etc.)
- Infliximab (IV): 5 mg/kg at 0, 2, 6 weeks, then every 8 weeks
- Adalimumab (SC): 160/80 mg at 0, 2 weeks, then 40 mg every 2 weeks
- Monitoring: Standard infection screening and vaccine update
- ECCO Note: Combine with immunomodulators to cut immunogenicity; infection risk rises.
- Cost (North East trust as of 2025): Adalimumab 40 mg pen approx £50; Infliximab 120 mg pen £200
Anti‑Integrin (Vedolizumab)
- Vedolizumab IV: 300 mg at 0, 2, 6 weeks, then every 8 weeks
- Vedolizumab SC: 108 mg every 2 weeks
- Monitoring: TB, viral hepatitis, HIV; check response by week 14
- ECCO Note: Gut‑selective; for moderate–severe UC or CD after other therapy.
IL‑12/23 & IL‑23 Inhibitors (Ustekinumab, Risankizumab, Mirikizumab, etc.)
- Ustekinumab: IV induction (weight‑based), then SC 90 mg every 8–12 weeks
- Risankizumab: IV 600 mg at 0, 4, 8 weeks (Crohn’s), then SC 360 mg every 8 weeks
- Mirikizumab: 300 mg IV at 0, 4, 8 weeks (UC; 900 mg for CD), then from week 12 SC 200 mg (UC) or 300 mg (CD) every 4 weeks
- Monitoring: CBC, LFT, TB screen; infection checks
- ECCO Note: Works in moderate–severe disease; option after anti‑TNF failure.
- Cost (North east trust 2025): Ustekinumab 130 mg vial approx. £300; Mirikizumab 300 mg vial £600
JAK Inhibitors (Tofacitinib, Filgotinib, Upadacitinib)
- Tofacitinib: 10 mg BD induction, 5 mg BD maintenance
- Filgotinib: 200 mg daily
- Upadacitinib: 45 mg daily induction, then 15–30 mg daily maintenance
- Monitoring: Lipids, FBC, LFT; watch infection risk (herpes zoster)
- ECCO Note: Rapid onset; check CV and thrombotic risks.
- Cost (North East trust 2025): Tofacitinib 5 mg × 56 approx. £300; Tofacitinib 10 mg × 56 £700; Upadacitinib 45 mg × 28 £800
S1P Receptor Modulators (Ozanimod, Etrasimod)
- Ozanimod: Titrate 0.23 mg → 0.46 mg → 0.92 mg daily
- Etrasimod: 2 mg daily
- Monitoring: Heart rate, ECG, LFT
- ECCO Note: Reduces lymphocyte trafficking; screen cardiac conduction.
References
Resource: ibd-eii.com/ibdcheatsheet
DOI: 10.5281/zenodo.13624693
Disclaimer
Note: All drug prices listed are approximate ballpark figures based on 2025 estimates at a trust in the North East. They are intended for educational use only and should not be relied upon for financial planning or modelling.