Uncontrolled Therapeutic Observations in Humans Using Biologic or Non-Biologic AgentsHIGH DOSE TOFACITINIB AS SALVAGE THERAPY IN STEROID REFRACTORY ACUTE SEVERE ULCERATIVE COLITIS FOLLOWING NON-RESPONSE TO INFLIXIMAB
Introduction
Acute Severe Ulcerative Colitis (ASUC) requiring hospitalization remains a serious concern in patients with Ulcerative colitis. In patients with steroid-refractory disease, Intravenous infliximab salvage therapy is used. Colectomy is reserved for patients refractory, even to salvage therapy. We present a young female with ASUC, who was successfully treated with high dose Tofacitinib after Steroids and Infliximab failure.
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Case History
A 23 years old female was diagnosed with pan-UC six months prior to the first presentation at our center. Since then, she has had a Steroid dependent disease. She was on the maximum 5-Aminosalicylic dose and could not tolerate azathioprine in the past. At the presentation, she had iron deficiency anemia (10.1 gm/dL), hypoalbuminemia (27 gm/L), C-reactive protein
4 mg/L and calprotectin of 670 mg/Kg. The colonoscopy showed pan-colitis Mayo score 3. Given her steroid dependency for the last six
Discussion
In Steroid refractory ASUC, with non-response to Infliximab, High-dose tofacitinib can be used as rescue therapy. Our patient showed clinical and biochemical remission within three days. At three months follow up, the patient remained colectomy-free and was in sustained remission.