Table 2.
Health maintenance recommendations for patients on immune suppressant and/or biologic therapy.
| Thiopurine | MTX | Anti-TNF-α | Anti-integrin | Combination | |
|---|---|---|---|---|---|
| Vaccinations | TdaP vaccine every 10 years | TdaP vaccine every 10 years | TdaP vaccine every 10 years | TdaP vaccine every 10 years | TdaP vaccine every 10 years |
| Influenza vaccine annually | Influenza vaccine annually | Influenza vaccine annually | Influenza vaccine annually | Influenza vaccine annually | |
| Pneumovax once then 5 years later | Pneumovax once then 5 years later | Pneumovax once then 5 years later | Pneumovax once then 5 years later | Pneumovax once then 5 years later | |
| Consider HPV vaccine in patients <26 years of age | Consider HPV vaccine in patients <26 years of age | Consider HPV vaccine in patients <26 years of age | Consider HPV vaccine in patients <26 years of age | Consider HPV vaccine in patients <26 years of age | |
| Laboratory monitoring | CBC and LFT every 2 weeks for 1 month then CBC & LFT at week 8 then CBC & LFT every 3 months | CBC and LFT every month for 4 months then CBC & LFT every 3months | CBC and CMP every 3–6 months | CBC and CMP every 3–6 months | See individual recommendations |
| Dermatologic | Annual or semi-annual skin exam | Annual or semi-annual skin exam | See anti-TNF and thiopurine recommendations | ||
| Avoid prolonged sun exposure, use sunscreen (≥SPF 15), and/or wear sun-protective clothing | Avoid prolonged sun exposure, use sunscreen (≥SPF 15), and/or wear sun-protective clothing | ||||
| Tuberculosis | Determine status (PPD/Mantoux or QuantiFERON Gold) prior to initiating therapy and annually thereafter | See anti-TNF-α recommendations | |||
| Hepatitis B† | Vaccinate if not immune | Vaccinate if not immune | Vaccinate if not immune Refer to hepatologist prior to initiating therapy if HBsAg or HBcAb positive | Vaccinate if not immune | See anti-TNF-α and thiopurine/MTX recommendations |
| Pneumocystis jirovecii prophylaxis‡ | Not recommended | Not recommended | Not recommended | Not recommended | Not recommended |
| Cervical dysplasia | Annual Pap smear | Annual Pap smear | Annual Pap smear | ||
All patients should be screened for hepatitis B (HBsAg, hepatitis B surface antibody, HBcAb) at diagnosis.
May be considered in patients on high-dose corticosteroids, patients on triple immune suppression, patients with lymphopenia or leukopenia, patients with multiple comorbidities particularly chronic obstructive pulmonary disease, patients older than 55 years of age [179].
CBC: Complete blood count; CMP: Comprehensive metabolic panel; HBcAb: Hepatitis B core antibody; HBsAg: Hepatitis B surface antigen; HPV: Human papillomavirus; LFT: Liver function tests; MTX: Methotrexate; PPD: Purified protein derivative; SPF: Sun protection factor; TdaP: Tetanus, diphtheria and pertussis.