Crohn Maintenance Therapy — RACP Adult Medicine MCQ

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EasyGastroenterologyCrohn Maintenance TherapyRACP Adult Medicine

A 25-year-old man with newly diagnosed moderate Crohn disease (ileal, non-stricturing non-penetrating) is commenced on budesonide for induction. He achieves remission. What is the most appropriate maintenance therapy?

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Correct answer: E — Azathioprine or 6-mercaptopurine

After induction of remission in moderate Crohn disease, immunomodulator maintenance (azathioprine 2-2.5 mg/kg or 6-MP 1-1.5 mg/kg) is appropriate for steroid-free maintenance. Budesonide and prednisolone are NOT appropriate for maintenance (ineffective and harmful long-term). Mesalazine has no proven role in Crohn maintenance (unlike UC). Check TPMT before starting thiopurines (HLA-B*5801 not relevant here — that's allopurinol). Monitor FBE/LFTs regularly.

Reference: GESA – 2024 – Crohn Disease; ECCO 2024