Immunosuppressants - GI

Infliximab is approved for the treatment of ulcerative colitis/Crohn's disease when prescribed according to NICE TAs (see links attached to drugs below). It is also approved for the management of diarrhoea or colitis related to immune checkpoint inhibitor (ICPI) therapy (unlicensed indication).

The JAK inhibitors upadacitinib, tofacitinib and filgotinib are all approved for the treatment of ulcerative colitis and upadacitinib for treating moderately to severely active Crohn’s disease in adults in accordance with NICE TAs (see NICE links attached to drugs). They are for specialist use only.

Risankizumab is approved for previously treated moderately to severely active Crohn's disease in people 16 years and over in accordance with NICE TA 888, and for treating moderately to severely active ulcerative colitis in accordance with NICE TA 998.

Mirikizumab is approved for treating moderately to severely active ulcerative colitis in accordance with NICE TA 925.

Etrasimod is approved for treating moderately to severely active ulcerative colitis in people aged 16 and over in accordance with NICE TA 956.

Mercaptopurine/Methotrexate/ciclosporin/azathioprine for inflammatory bowel disease (IBD) should be initiated by a specialist and used according to NICE guidelines and local shared care guidelines. Mercaptopurine for IBD, methotrexate for severe Crohn's disease and ciclosporin for severe acute UC refractory to corticosteroid treatment are all unlicensed uses. Click drug links above for specific drug listings and cautions.

Also refer to the Kent and Medway position statement for prescribing oral methotrexate.