Ileal colonic Crohn’s disease treated with combination azathioprine and standard maintenance dose anti-TNF therapy with new onset active symptoms.
Immune modulator, Pediatrics, Therapeutic drug monitoring
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.