Management of Ziltivekimab (IL-6 Inhibitor) During Colonoscopy
Ziltivekimab can be continued in patients undergoing colonoscopy as there is no evidence suggesting the need to discontinue IL-6 inhibitors prior to this procedure. 1
Rationale for Continuing Ziltivekimab
- Current guidelines from the British Society of Gastroenterology (2025) recommend that biologic therapies such as anti-TNF and anti-integrin agents can be continued in the preoperative period for patients undergoing surgery for inflammatory bowel disease 1
- While specific data on IL-6 inhibitors like ziltivekimab in the context of colonoscopy is limited, the approach is extrapolated from guidance on other biologics 1
- Ziltivekimab is a fully human monoclonal antibody targeting the IL-6 ligand that has been shown to reduce systemic inflammation 2, 3
Safety Considerations
- Colonoscopy is a less invasive procedure than surgery, and guidelines that permit continuation of biologics for surgical procedures would logically extend to colonoscopy 1
- Studies of ziltivekimab have not reported significant bleeding risks or other adverse events that would specifically contraindicate its use during endoscopic procedures 2, 4
- In a phase 1 trial, ziltivekimab demonstrated a favorable safety profile in patients with moderate-to-severe CKD and chronic inflammation 3
Management Recommendations for Patients on Ziltivekimab Undergoing Colonoscopy
Pre-procedure Assessment
- Review complete medication list, including any anticoagulants or antiplatelet agents that may be used concurrently 1
- Assess for risk factors that might increase bleeding risk, such as concomitant use of aspirin or NSAIDs 5
- Consider screening labs including CBC to assess baseline hemoglobin and platelet count 1, 2
During Colonoscopy
- Standard colonoscopy protocols should be followed 1
- If polypectomy is planned, be aware that while ziltivekimab itself has not been associated with increased bleeding risk, concomitant use with antiplatelet agents may increase this risk 5
- Colon capsule endoscopy is not recommended as a routine substitute for conventional colonoscopy 1
Post-procedure Monitoring
- Monitor for signs of bleeding, especially if polypectomy was performed 5
- Be vigilant for any signs of infection, although ziltivekimab has not been associated with increased infection risk in clinical trials 2, 4
Special Considerations
- For patients with inflammatory bowel disease (IBD), continuation of biologic therapy is particularly important to maintain disease control 1
- In patients with immune checkpoint inhibitor-related colitis, careful coordination with oncology is recommended if the patient is receiving ziltivekimab as treatment for this condition 1
- For patients with chronic kidney disease receiving ziltivekimab, no dose adjustments are needed for the colonoscopy procedure 2, 3
Conclusion
Based on the available evidence and guidelines for similar biologic agents, ziltivekimab can be safely continued in patients undergoing colonoscopy. The benefits of maintaining anti-inflammatory therapy likely outweigh any theoretical risks associated with the procedure 1, 4.