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Crohn’s Disease — UKMLA MCQ

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HardGastroenterologyCrohn’s DiseaseUKMLAMRCGP AKTPARAMRCEM SBAMRCP Part 1PSA

An adult with Crohn disease is receiving a conventional corticosteroid for a second inflammatory exacerbation within 10 months. Previous steroid tapers were successful, and thiopurines have not been used. Which add-on plan is supported?

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Correct answer: A — Check TPMT activity and add a thiopurine if activity is not deficient

The best answer is “Check TPMT activity and add a thiopurine if activity is not deficient”. NICE considers adding azathioprine or mercaptopurine to a conventional corticosteroid or budesonide when there are 2 or more inflammatory exacerbations in 12 months, or when the steroid dose cannot be tapered. TPMT activity is checked before treatment: deficient activity precludes a thiopurine and below-normal activity requires dose reduction. Normal TPMT does not remove the need for blood-count and liver monitoring or vigilance for neutropenia. Methotrexate is the alternative when thiopurines are not tolerated, are contraindicated or TPMT is deficient; corticosteroids and budesonide are not maintenance therapy.

Reference: NICE NG129, Crohn’s disease: management: https://www.nice.org.uk/guidance/NG129/chapter/recommendations