Advanced therapy screening

How to use it

Tick every drug you plan to start. The tool asks only the patient questions that matter for those drugs (for example heart failure for an anti-TNF, or recent MI and conduction disease for an S1P modulator). It then builds a checklist grouped as infection screen, vaccines, baseline tests, pregnancy and contraception, and drug-specific items. Each line names its source. Tick items as they are done; the chart note lists what is outstanding. Print checklist gives a clean copy.

Key points

Contraception after the last dose (Canadian monographs)

Methotrexate 6 months to 1 year; ozanimod 3 months; risankizumab 20 weeks; mirikizumab and guselkumab 12 weeks; tofacitinib 4–6 weeks; upadacitinib 4 weeks; etrasimod 7 days. For pregnancy planning, use the 2025 global consensus on IBD in pregnancy and the pregnancy assistant, which stops methotrexate and small molecules 3 months before trying to conceive. Thiopurines: the consensus supports continuing an established thiopurine through conception, pregnancy and breastfeeding. The Canadian label is more restrictive; follow the IBD consensus.

Pitfalls

• Vedolizumab: the monograph says TB screening “should be considered according to local practice”.
• Ozanimod is contraindicated with MAO inhibitors and needs a dose titration. It is licensed only for UC in Canada, as is etrasimod.
• Upadacitinib (Rinvoq monograph, 2025): caution with diverticular disease, past diverticulitis, or NSAIDs, steroids or opioids (GI perforation); hypoglycemia on diabetes medicines; tablet residue in stool or ostomy output with short transit.
• Tofacitinib has not been studied with positive hepatitis B or C serology, and the monograph says not to use it in these patients.
• Methotrexate is off-label in IBD in Canada.
• Vaccines: the Canadian Immunization Guide (NACI 2025, strong recommendation) advises 2 doses of recombinant zoster vaccine for every adult 18 or older who is or will be immunocompromised. Finish the series at least 14 days before starting; before therapy the second dose can be given 4 weeks after the first. This replaces CAG 2021’s age split (recommended at 50+, suggested under 50). For pneumococcal disease, give one dose of Pneu-C-20 or Pneu-C-21, at least 8 weeks after any earlier pneumococcal vaccine.
• Latent TB: start latent TB treatment before the drug. ECCO 2026 asks for at least 3–4 weeks of it before an anti-TNF or JAK inhibitor (or both together if the need is urgent); vedolizumab, ustekinumab, IL-23 inhibitors and S1P modulators can start at the same time as latent TB treatment.
• EBV: EBV-negative patients, especially young men, have a higher lymphoma risk on thiopurines. BSG 2025 suggests discussing other options for seronegative patients before a thiopurine or anti-TNF.
• This list does not replace the full product monograph.

Where ECCO 2026 and Canadian guidance differ

The 2026 ECCO infections guideline (July 2026) differs from Canadian guidance on a few points. The tool follows the Canadian source each time.