The treatment landscape for inflammatory bowel disease (IBD) has changed dramatically over the past few decades. Treatment goals now extend beyond controlling symptoms to include mucosal healing, reduction of disease complications, and improved long-term outcomes. The growing number of therapies has created more opportunities to individualize treatment, while also introducing new monitoring and patient education opportunities. This overview summarizes the major biologic and advanced therapies used in Crohn’s disease and ulcerative colitis, with a focus on key nursing considerations relevant to home infusion therapy (HIT).
The Evolving Approach to IBD Treatment
Corticosteroids and immunomodulators continue to have a role in treatment. However, recent advances in IBD care have largely been driven by therapies that target specific parts of the immune response, allowing for a more focused approach to disease management. Treatment today is more individualized, based on factors such as disease severity, location of the disease, therapies tried and failed, comorbidities, and patient preferences.
Biologic Therapies
Several important considerations apply when using biologic therapies to treat IBD, including:
- Educate patients on infection prevention and screen for active infections.
- Watch closely for infusion or injection-site reactions.
- Advise patients to be compliant with premedication regimen, if ordered.
- Monitor for hypersensitivity reactions during and after infusions.
- For self-injectable therapies, teach administration techniques carefully, as adherence problems can arise in patients who are not confident.
- For drugs that require lab monitoring, reinforce the importance of staying compliant with lab orders
Anti-TNF drugs were the first biologics used to treat IBD, and they’re still widely used today. These include:
- Infliximab (Remicade® and biosimilars) (IV), (Zymfentra®) (SUBQ)
- Adalimumab (Humira® and biosimilars) (SUBQ)
- Certolizumab pegol (Cimzia®) (SUBQ) (Crohn’s disease)
- Golimumab (Simponi®) (SUBQ for ulcerative colitis)
Key considerations include:
- Testing and screening for symptoms of tuberculosis (TB) and hepatitis B must be completed before starting therapy. Inform the patient’s clinical team about positive screening results.
- Adherence to the dosing schedule is important, as treatment interruptions may contribute to antibody formation and reduced treatment response.
Vedolizumab (Entyvio®) is a gut-selective integrin receptor antagonist. Because it stays fairly localized to the gut, it tends to have a more favorable systemic safety profile than some of the older biologics.
Key considerations include:
- It can be given IV or subcutaneously depending on the formulation.
- Reinforce that clinical response may take several weeks so patients do not become discouraged early in treatment.
- Although it is gut-selective, routine infection monitoring is still required.
Ustekinumab (Stelara®) is an IL-12 and IL-23 antagonist that reduces inflammatory signaling involved in IBD. It targets two cytokine pathways with a single therapy.
Key considerations include:
- Treatment starts with an IV-induction dose, followed by subcutaneous maintenance injections.
IL-23 Inhibitors selectively inhibits IL-23 while preserving IL-12 activity. This more targeted approach expands treatment options for IBD. These include:
- Risankizumab (Skyrizi®)
- Mirikizumab (Omvoh®)
- Guselkumab (Tremfya®)
Key considerations include:
- Treatment starts with an IV-induction dose, followed by subcutaneous maintenance injections, except for Guselkumab, which has a regimen for SUBQ induction instead of IV.
Non-biologic Therapies
JAK Inhibitors block intracellular inflammatory signaling pathways. Unlike biologics, they are administered orally rather than by infusion or injection. These include:
- Upadacitinib (Rinvoq®)
- Tofacitinib (Xeljanz®) (Ulcerative colitis)
Key considerations include:
- Educate patients on infection prevention and screen for active infections.
- Reinforce the importance of staying compliant with lab orders, which may include CBC, liver enzymes, and lipids.
- Tuberculosis (TB) testing must be completed before starting therapy followed by continuous screening for TB symptoms. Inform the patient’s clinical team about positive screening results.
- Patients should know the warning signs of blood clots and cardiovascular events.
S1P Receptor Modulators reduce GI inflammation by preventing lymphocytes from leaving lymph nodes and migrating to the intestinal tract. They are also administered orally. These include:
- Ozanimod (Zeposia®) (Ulcerative colitis)
- Etrasimod (Velsipity®) (Ulcerative colitis)
Key considerations include:
- Educate patients on infection prevention and screen for active infections.
- May cause transient decrease in heart rate.
- Monitor blood pressure during treatment.
- Dose titration is required.
- Patients should be monitored for changes in vision.
- Reinforce the importance of staying compliant with lab orders, which may include CBC and liver enzymes.
How Providers Select the Appropriate Therapy
There’s no single formula, but the factors that usually drive the decision are:
- Disease type and severity
- How the patient responded to prior treatment
- Extraintestinal manifestations
- Age and comorbidities
- Pregnancy considerations
- Preferred route of administration
- Insurance coverage and access
The Role of Nursing in IBD Care
The effectiveness of these therapies depends on consistent day-to-day management. Nurses play a central role through patient education, medication administration and monitoring, assessment of treatment response, early identification of adverse events, adherence support, coordination of laboratory testing and follow-up, and assistance with integrating treatment into daily life. These responsibilities often make nurses a trusted and essential resource for patients.
The Bottom Line
The IBD treatment landscape continues to evolve, with the expanding treatment options and increasingly individualized approaches to care. Staying current with therapy-specific administration, monitoring, and safety considerations help support optimal patient outcomes. As always, consult current prescribing information and organizational protocols when applying treatment-specific recommendations in practice.
References
1. Lichtenstein GR, Loftus EV, Afzali A, et al. ACG Clinical Guideline: Management of Crohn’s Disease in Adults. *Am J Gastroenterol.* 2025;120(6):1225-1264.
2. Rubin DT, Ananthakrishnan AN, Siegel CA, Barnes EL, Long MD. ACG Clinical Guideline Update: Ulcerative Colitis in Adults. *Am J Gastroenterol.* 2025;120(6):1187-1224.
3. Manufacturer package inserts
*Note: Biologic and small-molecule labeling for IBD is updated frequently as new data and indications are approved. Always check the current FDA label (accessdata.fda.gov) or your pharmacy’s reference before applying dosing or safety information in practice.*
