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Treat to Target in CD
Interactive Case Challenge 1: Treat-to-Target in Crohn’s Disease 

Released: March 17, 2025

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Case History and Presentation


Lisa Lewis is a 28-year-old woman with a 4-year history of CD (SES-CD of 10). She presents with ongoing moderate to severe disease activity despite current therapy. She has experienced intermittent flares with poor symptom control. She reports abdominal pain, fatigue, and 4-5 loose stools daily. Her weight has been stable. Recent colonoscopy showed mucosal inflammation and ulceration in the terminal ileum.


Current therapy includes azathioprine 150 mg/day and adalimumab 40 mg every 2 weeks. 


Past medical history: diagnosed with CD at age 24, initial disease location: terminal ileum (Montreal classification L1). No history of strictures, fistulas, or perianal disease. Previous treatments: initially treated with corticosteroids for symptom control, started on azathioprine 150 mg daily at diagnosis, began adalimumab 40 mg every 2 weeks two years ago due to persistent symptoms despite azathioprine monotherapy. No surgical history or hospitalizations in the past year. No known family history of inflammatory bowel disease (IBD).



  • Vitals: afebrile; blood pressure: 120/76 mm Hg; heart rate: 74 beats/min; BMI: 23 kg/m²

  • Recent laboratory findings: 

    • CRP: 12 mg/L  

    • Fecal calprotectin: 350 µg/g  

    • Hemoglobin: 13.2 g/dL  

    • Albumin: 4.1 g/dL  

    • Liver function tests: normal 

    • White blood cell count: 6.8 x 109/L

    • Trough adalimumab level: 3.4 mcg/mL  



What is the most appropriate next step in her treatment?