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Crohn – biologic escalation — RACP Paediatrics MCQ

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ModerateGICrohn – biologic escalationRACP Paediatrics

A 10-year-old with Crohn disease has failed to maintain remission on azathioprine with two flares in 6 months. Growth velocity has declined. What is the most appropriate escalation therapy?

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Correct answer: D — Infliximab

Anti-TNF therapy (infliximab or adalimumab) is indicated for moderate-severe paediatric Crohn disease refractory to conventional immunomodulators (azathioprine/methotrexate) or for steroid-dependent disease. Early introduction of biologics is increasingly advocated, especially when there are risk factors for complicated disease (perianal disease, growth failure, extensive disease).

Reference: RCH Melbourne – 2023 – IBD CPG; ESPGHAN – 2024 – Paediatric Crohn Disease Guidelines