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Juvenile dermatomyositis — SCE Rheumatology MCQ

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HardPaediatric rheumatologyJuvenile dermatomyositisSCE Rheumatology

A patient on tocilizumab has repeat ALT 6.2 times the laboratory upper limit of normal after viral, ischaemic and obstructive causes are assessed. What is the product-specific action?

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Correct answer: B — Discontinue tocilizumab at the fivefold SmPC threshold

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

D is correct. The tocilizumab SmPC directs discontinuation when ALT or AST exceeds five times the upper limit of normal. A delays action at a clear stop threshold. B invents a higher threshold. C adds another potentially hepatotoxic medicine. E states the required product-specific action after confirmation and assessment of competing causes. Lesser elevations use different interruption and restart rules, so the decision should be based on the actual multiple of the local upper limit rather than a generic “abnormal liver test” label.

Reference: UK RoActemra summary of product characteristics: https://www.medicines.org.uk/emc/product/6673/smpc