S3271 Rescue Therapy During Pregnancy With Ciclosporin in a Challenging Case of Ulcerative Colitis
Notice bibliographique
Résumé
Introduction: Optimizing ulcerative colitis (UC) management during pregnancy remains challenging, considering maternal and fetal complications. Ciclosporin can induce remission in steroid-refractory UC. We present a successful ciclosporin therapy in pregnancy in a severe UC flare refractory to multiple advanced therapies. Case Description/Methods: A 25-year-old woman with a history of hypothyroidism was diagnosed with pancolitis UC at 18. She was unresponsive to mesalamine and infliximab and received 6-month steroids within the first year of diagnosis. Vedolizumab was started and discontinued after the second dose due to cost. She received a 2-month therapy with tofacitinib, which was ineffective and stopped as she moved countries. Her UC improved over time. Clinical remission was reported while she got pregnant and during her first and second trimesters of pregnancy without therapy. At the 30th gestational week, she was admitted with acute onset of frequent bloody, loose bowel movements in the context of Clostridioides difficile colitis. A 10-day oral vancomycin course was completed with minimal response. A colonoscopy showed Mayo 3 pancolitis. Intravenous steroids were started; oral vancomycin was continued. She was followed by obstetric service. Vedolizumab was initiated; however, given a need for a rapid induction agent, cyclosporin was started at 2mg/kg. Within a few days, her clinical symptoms improved, and the C-reactive protein level dropped from 16.6 mg/L to 3.5 mg/L (< 5.0 mg/L). Meanwhile, she received a pulse-tapered vancomycin regimen. She was discharged home on oral cyclosporin 300mg daily, followed by trough levels, for a total of 6 weeks. At 41 weeks of gestation, a healthy 2.92 kg baby was delivered via an uncomplicated vaginal delivery. Post-partum, she continued vedolizumab. Despite dose escalation, she was unresponsive. Ustekinumab was started with a transition to every 8-week subcutaneous dosing. After 24 weeks, she was in clinical remission. She has stayed steroid-free for 2 years with a recent colonoscopy of Mayo 0 disease. Discussion: Selecting appropriate therapy in UC flare in pregnancy requires a multidisciplinary team. Despite emerging data on using jak-inhibitors for severe fulminant hospitalized UC, they are contraindicated in pregnancy. Hence, this case demonstrates there is still a role for ciclosporin in pregnancy.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,000 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».