S2726 Five Crohn’s Disease Patients Treated With Vedolizumab for Pyoderma Gangrenosum
Bibliographic record
Abstract
Introduction: Management of pyoderma gangrenosum (PG) is complex due to limited data from extensive studies to guide treatment options. Vedolizumab (VDZ) is a promising new biologic that has shown benefit in treating PG based on case reports. We performed a retrospective chart review to investigate the role of VDZ for the treatment of Ulcerative Colitis (UC) or Crohn’s Disease (CD) associated PG. Case Description/Methods: Using the McKesson billing database, we identified patients with UC or CD-associated PG treated with VDZ between January 1, 2016, and December 31, 2019, at Baystate Medical Center, a 715-bed teaching hospital in western Massachusetts. Sixty-two charts came up in the search and were reviewed manually. Five met our inclusion criteria, and a chart review of these patients’ clinical histories was performed with patient characteristics recorded in Table. Case #1 was a 38-year-old woman with colonic CD diagnosed at age 30, status post subtotal colectomy with end ileostomy, complicated by arthralgias and severe PG of her face, legs, and peristoma, who was followed for CD and recurrent PG. She was steroid dependent for nearly the entire duration of her disease, unable to wean below 20 mg daily prednisone without her PG flaring. Adalimumab, infliximab, sulfasalazine failed to control her PG. She was started on VDZ, and after her fourth induction dose, her PG lesions were in complete resolution / remission. After three months of maintenance infusions, she was tapered to 5 mg daily prednisone. Three years later, her PG remains in remission with VDZ (Figure). Case #5 was a 47-year-old man with colonic CD, diagnosed at age 30, complicated by anorectal stricture and fistulization, status post multiple seton placements and left hemicolectomy with Colo vesical fistula repair and a right transverse colostomy, who had peristomal PG that did not improve with adalimumab for eight months and mesalamine. He was started on VDZ, and at his four-month follow-up, he reported complete resolution of his peristomal PG. He has remained on VDZ therapy for the last five years with no recurrence of PG reported. Discussion: In conclusion, 2 out of 5 of our CD patients with PG responded favorably to VDZ. Our case series suggests that VDZ can be an effective treatment for refractory PG in CD patients; however, given the paucity of data, larger studies are needed.Figure 1.: Case 1’s peristomal pyoderma gangrenosum in remission after approximately one year of vedolizumab therapy. Table 1. - Patient characteristics Case #1 Case #2 Case #3 Case #4 Case #5 Age 38 65 33 44 47 Sex Female Male Female Female Male BMI 49.8 36.1 27.8 34.9 24.4 IBD type CD CD CD CD CD Montreal Classification A2 L2 B3 A2 L2 B2 A2 L2 B3p A2 L3 B3p A2 L2 B3p Duration of IBD 8 years Unknown 10 years 26 years 17 years Associated medical conditions Morbid obesity, obstructive sleep apnea, iron deficiency anemia, thyroid nodule Varicose veins Depression, hypertension, hyperilpidemia, psoriasis, irritable bowel syndrome Type 2 diabetes Insomnia, alcohol use Other extra intestinal manifestations Arthralgias None Arthralgias None None PG site(s) Face, peristomal, legs Peristomal Legs Breasts, perineum, labia Peristomal Failed biologic therapy Adalimumab, infliximab Adalimumab Infliximab, adalimumab, ustekinumab, certolizumab pegol Adalimumab, infliximab, certolizumab pegol Infliximab, adalimumab PG response to VDZ Improved Not improved Not improved Not improved Improved
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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) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 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".