At a glance
- Before you start, you will need blood tests for hepatitis B and C and a TB test. Some pills also need a heart tracing (ECG) or cholesterol test.
- Get any live vaccines (like MMR or chickenpox) at least 4 weeks before you start. You can't have them while on treatment.
- Get other vaccines, like Shingrix and the flu shot, before you start if you can. They are still safe once you are on treatment.
- Call your IBD team if you have a fever or an infection, or are given antibiotics, before your next dose.
- Don't stop or skip doses without talking to your team, even for surgery or travel.
- See a travel clinic early. Some travel vaccines, like yellow fever, are live and not allowed.
- Planning a pregnancy? Tell your team before you try, so your plan is safe for you and the baby.
- Ask about the drug maker's patient support program. Its staff can help with insurance forms, teaching and booking.
What is advanced therapy?
Advanced therapy means a biologic or one of the newer IBD pills. These medicines block a signal that drives inflammation in the gut. They are used for moderate to severe Crohn’s disease or ulcerative colitis. Read How IBD treatment works for the main groups.
Starting one is a big step. A little planning makes it safer and smoother.
Tests before you start
These medicines can make some infections more likely. Some old infections can also wake up. So your team checks first.
Tests you will likely have
- Hepatitis B and C blood tests. In rare cases, hepatitis B can wake up on these medicines. Finding it first means it can be treated or watched.
- A TB test. This is a skin test or a blood test, often with a chest X-ray. TB can hide in the body for years. If you have it, you may need TB treatment first.
- Other blood tests, such as blood count, liver and kidney tests. Some people are also tested for HIV.
- A stool calprotectin test, to know your starting point.
- For S1P pills (ozanimod, etrasimod): a heart tracing (ECG). Some people also need an eye exam.
- For JAK pills (tofacitinib, upadacitinib): a cholesterol test.
Tell your team if you have had heart failure, multiple sclerosis, cancer, blood clots, or TB, or if you have lived in or travelled to a place where TB is common. These can change which medicine is best.
Vaccines first
Vaccines work best before your immune system is turned down. But don’t delay urgent treatment just to get vaccines.
- Live vaccines (such as MMR and chickenpox) must be given at least 4 weeks before you start. You can’t have live vaccines while on treatment. If you stop treatment, you usually need to wait at least 3 months before you can have one.
- Non-live vaccines are safe during treatment. They work best if given at least 2 weeks (better, 3 to 4 weeks) before you start.
- Shingrix (the shingles vaccine) is not live. Canada advises it for all adults 50 and over, and for any adult 18 or older who is on, or about to start, a medicine that weakens the immune system. It is especially important before a JAK pill. You need 2 doses.
- Keep up with the flu shot each year, plus COVID-19, pneumonia and hepatitis B vaccines as advised.
- Live vaccinesAt least 4 weeks
- Non-live vaccinesAt least 2 weeks, best 3 to 4
See Vaccines and IBD for the full list.
How each one is given
| How | Medicines | What it is like |
|---|---|---|
| IV drip (infusion) | infliximab, vedolizumab. Also the first doses of ustekinumab, risankizumab, mirikizumab and guselkumab | Given in an infusion clinic. A nurse watches you during the drip |
| Shot under the skin | adalimumab, golimumab, and some forms of infliximab and vedolizumab. Also the ongoing doses of ustekinumab, risankizumab, mirikizumab and guselkumab | You give it yourself at home with a pen or syringe, after a nurse teaches you |
| Pill | tofacitinib, upadacitinib, ozanimod, etrasimod | Taken by mouth at home, every day |
For Crohn’s disease, guselkumab (Tremfya) can also be started with shots at home instead of a drip.
Some medicines start with a few doses close together, then move to a regular schedule. Keep a calendar so you don’t miss a dose. Follow the storage directions from your pharmacy. Many pens go in the fridge.
What to expect
- Timing. Your team will check how you are doing about 2 to 4 months after you start. You’ll have blood and stool tests before visits. Some people feel better within weeks. For others it takes longer.
- Side effects. Shots can leave a red or sore spot. Tell your nurse if you feel unwell during an infusion. Your team will tell you about the side effects of your medicine.
- Watch for: fevers you can’t explain, night sweats, or weight loss you can’t explain. Tell your team.
- If it doesn’t work well enough, your team may adjust the dose or switch medicines. There are many options.
Infections: when to call
You may catch infections a bit more easily. Wash your hands often and keep your vaccines up to date.
Call your IBD team before your next dose if you:
- Have a fever, or feel sick with an infection
- Are prescribed antibiotics
- Have a painful rash with blisters (it may be shingles)
- Have a cough that won’t go away, or night sweats, especially after travel or contact with someone with TB
Your team will tell you whether to wait on your next dose. Don’t stop your medicine on your own.
Travel, surgery and dental work
Travel. See a travel clinic as early as you can before you go. Some travel vaccines are live, like yellow fever and oral typhoid. You can’t have these on treatment. Non-live travel vaccines, like hepatitis A, are fine. Pack your medicine in your carry-on bag, with a note from your doctor. Plan doses around your trip with your team.
Surgery or dental work. Tell your surgeon or dentist that you take an IBD medicine. Tell your IBD team, too. They may plan your doses around the surgery. Don’t stop on your own.
Pregnancy and family planning
Many biologics can be used safely during pregnancy. Stopping them can lead to a flare, and a flare is risky for you and the baby.
Some medicines are not used in pregnancy: methotrexate and the newer IBD pills (tofacitinib, upadacitinib, ozanimod and etrasimod). If you take one of these and could get pregnant, use birth control. Talk to your team before you try, so they can switch you to a medicine that is safe in pregnancy. Read Pregnancy and IBD.
Paying for it
Advanced therapies cost a lot. Most people need help paying for them, and there are several options.
- Private insurance through work or school often covers them. You may need forms from your doctor first.
- Public plans in Ontario include the Ontario Drug Benefit for people who qualify, and the Trillium Drug Program for people whose drug costs are high compared to their income. If you are 24 or younger and have no private plan, OHIP+ covers many drugs. The Ontario Drug Benefit covers the biosimilar version when one exists. Your doctor may need to send a form first.
- Patient support programs are run by each drug maker in Canada. Joining is optional. Program staff can help with insurance paperwork, set up infusions, and teach you how to inject. If you switch medicines, you switch programs.
Ask your IBD team who can help with this.
How long will I be on it?
If it works, most people stay on it to keep IBD calm. Stopping later is possible for some people, but the risk of a flare is real. See Thinking about stopping your IBD medicine.
Can I drink alcohol?
Ask your team. It depends on your medicine and your liver tests. Some IBD medicines need extra care with alcohol.
Sources for this guide
Sources
- Narula N, Leung Y. Induction of Advanced Therapy clinical care pathway. Crohn's and Colitis Canada PACE IBD Clinical Care Pathways, version January 21, 2026. Pre-treatment work-up: hepatitis B (HBsAg, HBsAb) and C, HIV if at risk, chest X-ray and TB skin test or QuantiFERON; ECG (and eye exam if at risk) before S1P modulators; lipids before JAK inhibitors; anti-TNF not used with NYHA III–IV heart failure or multiple sclerosis; vaccines up to date; review insurance; reassess at 2–4 months; routes and schedules of each agent.
- Nistor I, Huang V. Health Maintenance clinical care pathway. Crohn's and Colitis Canada PACE IBD Clinical Care Pathways, version January 21, 2026. No live vaccines on immunosuppression; Shingrix for all adults 50+ and adults 18+ on JAK inhibitors, steroids or combination therapy; yearly TB risk review and retesting after TB contact or travel to a TB-endemic area; watch for unexplained fever, night sweats and weight loss.
- deBruyn J, Kroeker K. Vaccination Guide for Patients with IBD clinical care pathway. Crohn's and Colitis Canada PACE IBD Clinical Care Pathways, version December 18, 2024. Live vaccines at least 4 weeks before and at least 3 months after immunosuppression; inactivated vaccines at least 2 (preferably 3–4) weeks before starting but safe during treatment; yellow fever, oral typhoid and BCG are contraindicated when immunosuppressed; Shingrix recommended before JAK inhibitors at any age.
- Benchimol EI, Tse F, Carroll MW, et al. Canadian Association of Gastroenterology clinical practice guideline for immunizations in patients with inflammatory bowel disease (IBD) — Part 1: Live vaccines. Gastroenterology 2021;161:669–80. PMID 33617891 Review vaccines at diagnosis; give needed vaccines as soon as possible; don't delay urgently needed treatment for vaccines; live vaccines are not recommended on immunosuppressive therapy.
- Public Health Agency of Canada. Canadian Immunization Guide, Part 3: Immunization of immunocompromised persons (last partial update September 2026). Live vaccines at least 4 weeks before immunosuppression; non-live vaccines at least 2 weeks before when possible; recombinant zoster vaccine for adults 18+ who are or will be immunocompromised.
- Public Health Agency of Canada. Canadian Immunization Guide, Part 4: Herpes zoster (shingles) vaccine (partial update June 2025; accessed October 2026). Recombinant zoster vaccine, 2 doses, for adults 50 and older and for adults 18 and older who are or will be immunocompromised; finish at least 14 days before immunosuppression if possible. Supersedes the narrower PACE pathway wording (50+, or 18+ on JAK inhibitors, steroids or combination therapy).
- West Hertfordshire Teaching Hospitals NHS Trust. Managing a Crohn's or colitis flare-up (patient leaflet, v3, ratified June 2026). Do not adjust immunosuppressant or biologic doses without your IBD team; if you have signs of infection, ask your team for advice; go to emergency for signs of a serious allergic reaction.
- Squirell E, Rosenfeld G, Bressler B, Meade S, et al. Pregnant pause? Not for IBD care. Crohns Colitis 360 2025;7:otaf029. PMID 40401215 Biologic use was stable in pregnancy without a significant effect on outcomes; supports continuing medical therapy through pregnancy.
- Squirell E, Meade S, Leung Y. The fundamentals of IBD management in pregnancy: a practical review for the gastroenterologist. J Can Assoc Gastroenterol 2024;7:121–31. PMID 38314178 Methotrexate and small molecules are contraindicated in pregnancy; most 5-ASA, biologics and thiopurines can continue.
- Mahadevan U, Seow CH, Barnes EL, et al. Global consensus statement on the management of pregnancy in inflammatory bowel disease. J Crohns Colitis 2025;19(8):jjaf129. PMID 40914850 Data on many IBD medicines in pregnancy are limited; maternal health best supports infant health.
- Gastrointestinal Society (Canada). IBD patient support programs when starting biologic medication (accessed October 2026). Manufacturer-funded patient support programs help with insurance (public, private or both) and paperwork, nurse support and scheduling; joining is optional.
- Government of Ontario. Get help with high prescription drug costs (Trillium Drug Program) (accessed October 2026). For Ontario residents who don't qualify for ODB and spend about 4% or more of after-tax household income on prescription drugs.
- Government of Ontario. Biosimilars (Ontario Drug Benefit policy), updated December 15, 2025. ODB recipients new to infliximab, adalimumab or ustekinumab start on a biosimilar.
- Government of Ontario. Learn about OHIP+ (updated February 11, 2026). People 24 and under with OHIP and no private plan are covered for drugs on the Ontario Drug Benefit program; no sign-up needed; coverage ends at 25 or when a private plan starts.
- Johnson & Johnson Canada. Health Canada authorizes Tremfya (guselkumab) for Crohn's disease (news release, July 31, 2025). Crohn's disease induction can be 200 mg IV or 400 mg under the skin at weeks 0, 4 and 8; maintenance is under the skin. For ulcerative colitis (NOC September 3, 2025, CDA-AMC review SR0874), induction is IV.
- Janssen Inc. REMICADE (infliximab) product monograph, Health Canada Drug Product Database, 2019. Assess for TB, including latent TB, before starting, and treat latent TB first; test for hepatitis B before starting (reactivation has occurred very rarely).
This guide is for general education. It can't replace advice from your own care team, who know your health history.