High-Dose Rescue Tofacitinib Prevented Inpatient Colectomy in Acute Severe Ulcerative Colitis Refractory to Anti-TNF
Bibliographic record
Abstract
To the editors, Acute severe ulcerative colitis (ASUC), as defined by the Truelove-Witts criteria,1 is a medical emergency. The mainstay of treatment remains hospitalization, exclusion of infection, high-dose intravenous steroids, medical rescue with infliximab/cyclosporine in patients who do not respond, or colectomy.2 However, in patients with previous failure with infliximab, there is no medical treatment in the hospitalized setting with proven efficacy, and major safety concerns have been noted using sequential-medical therapy with cyclosporin/infliximab.3 Although several agents are approved for the treatment of moderate-to-severe ulcerative colitis (UC), including vedolizumab (anti-integrin), tofacitinib (oral Janus-kinase inhibitor), and ustekinumab (interleukin-12/23 antagonist), none have proven efficacy for ASUC.4 We present a report of a male patient dependent on steroids with severe UC and oral ulceration, refractory to high-dose infliximab, and hospitalized with ASUC who was successfully rescued with high-dose, off-label tofacitinib before a successful transition to standard dosing, achieving clinical,...
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".