S3271 Rescue Therapy During Pregnancy With Ciclosporin in a Challenging Case of Ulcerative Colitis
Bibliographic record
Abstract
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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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 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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".