Title :

Ileal colonic Crohn’s disease treated with combination azathioprine and standard maintenance dose anti-TNF therapy with new onset active symptoms.

Category :

Immune modulator, Pediatrics, Therapeutic drug monitoring

Drug :

Anti-TNF therapy, Azathioprine

IBD Horizon’s Annual Seattle Symposium Fall 2016

    • 17 year old female with 2 year history of Crohn’s who initially presents with ileal colonic severe ulceration on ileo-colonoscopy

Initially treated with prednisone with response.

  • After taper of prednisone symptoms returned. Restarted prednisone and after attaining normal TPMT, initiated Azathioprine (2.5 mg/kg)
  • After 8 weeks, was ‘therapeutic’ on Azathioprine without remission
  • Anti-TNF added. Patient in complete remission
  • Two years later, patient has symptoms of active Crohn’s.
  • Reports good adherence to both medications.
  • No recent travel or recent antibiotic usage

Conclusions: Inflammation should be confirmed as the source of these symptoms (vs IBS, fistula or stricture). Drug monitoring with trough and antibody levels should guide next steps: escalate anti-TNF dose if subtherapeutic, change to another agent within same class if high antibody titer, or change to a different class (e.g anti-adhesion molecules) if therapeutic level.

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