319https://www.ecco-ibd.eu), and reputable Internet sites. Although patients can get
reliable and easily understandable information about almost all aspects of IBD from
these resources, they should be encouraged to discuss questions and concerns with
their prescribing healthcare provider.
Screening Tests
Prior to starting biologic therapy, appropriate screening to identify active and latent
infections should be performed. When any active or latent infection such as
Clostridium difficile (C. difficile), Cytomegalovirus (CMV), or Epstein-Barr virus
(EBV) is identified, biologic therapies should generally be deferred until appropri-
ate treatment has been initiated or until clinical resolution of the active infection.
Anti-TNF Therapy
Before starting anti-TNF therapy, screening for latent tuberculosis (TB) and hepati-
tis B virus (HBV) should be performed, and doing so is an indicator of good quality
of care [ 23 ]. In addition, screening for other infections should be considered based
on patient-specific factors (i.e., travel to endemic areas for various infectious) and
geographic risk (i.e., histoplasmosis in high-risk regions) (Table 18.2).
Risk factors for latent TB include a prolonged stay (>3 months) in a high TB
incidence area, close contact with patients with active TB, radiological evidence of
Table 18.2 Suggested checklist of screening and baseline tests before starting biologic therapy
- Appropriate screening to identify active and latent infections as clinically warranted
- Anti-TNF therapy screening tests
− Latent tuberculosis (TB)—PPDa skin test or IGRAbtest, CXR as indicated for higher-risk
individuals
− Hepatitis B virus (HBV)—HBsAg, HBsAb, HBcAb - Anti-integrin therapy screening test
− Anti-JCV antibody test (prior to initiation of natalizumab)
− Screening of TB (according to the local practice before vedolizumab)
− Screening of HBV and other hepatitis viruses (provider discretion) - Anti-IL12/IL23 (ustekinumab)
− Latent tuberculosis (TB)—PPDa skin test or IGRAbtest, CXR as indicated for higher-risk
individuals - Baseline tests before all biologics
− Complete blood counts, chemistries with liver enzymes, inflammatory markers
(sedimentation rate, CRP, with or without fecal calprotectin)
− Consider colonoscopy and/or small bowel imaging, as clinically warranted
aPurified protein derivative
bInterferon-γ release assays
18 Quality, Safety, and Practical Considerations of Using Biologic Therapies