Letter: a case supporting the use of rescue infliximab therapy for fulminant ulcerative colitis in pregnancy – authors’ reply
Bibliographic record
Abstract
Forgan-Smith et al.1 report a case of a young female patient with acute severe flares of ulcerative colitis, who has been successfully treated during three consecutive pregnancies with infliximab rescue therapy. In our own clinical practice, we have been using infliximab therapy in similar settings with similar results and without any relevant side effects in both the mother and the newborn. Our recommendation to consider discontinuation of infliximab in the third trimester because of safety concerns focused on patients in stable remission after thoroughly balancing risks and benefits.2 Acute severe colitis has to be treated immediately with highly efficacious drugs during pregnancy, and infliximab therapy represents one feasible therapeutic option among others (e.g. other anti-TNF-agents, ciclosporin, tacrolimus2) as demonstrated in the case report by Forgan-Smith et al. We have for instance reported a successful rescue therapy with tacrolimus in a pregnant patient with glucocorticosteroid-refractory ulcerative colitis.3 Nevertheless, we think that management of severe ulcerative colitis during pregnancy cannot be generally standardised, and that these patients should be managed and supervised jointly by gastroenterologists and obstetricians, who have sufficient experience with immunosuppressive therapy and complicated inflammatory bowel disease.2 The authors’ declarations of personal and financial interests are unchanged from those in the original article.2
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.018 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.004 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.023 | 0.012 |
| Insufficient payload (model declined to judge) | 0.004 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".