Alimentary Pharmacology and Therapeutics
Letters to the Editors Letter: a case supporting the use of rescue infliximab therapy for fulminant ulcerative colitis in pregnancy K. R. Forgan-Smith & J. E. Roche Department of Gastroenterology, The Townsville Hospital, Townsville, Australia. E-mail: [email protected] doi:10.1111/apt.13037
SIRS, Managing inflammatory bowel disease (IBD) during pregnancy can be challenging.1 We would like to share our experience of a patient with ulcerative colitis (UC) who experienced three severe flares, during each of her three pregnancies, that on each occasion was successfully treated with Infliximab rescue therapy. This patient was diagnosed elsewhere with mild proctitis at age twenty-two; she was not commenced on treatment. Twelve months later, she presented with acute severe colitis in the first trimester of her first pregnancy. She failed to respond to intravenous steroids. After consultation with an obstetrician and colorectal surgeon, she received rescue therapy with infliximab (0, 2 and 6 weeks); she achieved clinical remission after the first dose and was commenced on Azathioprine and Sulphasalazine. She remained in remission and delivered a healthy baby at term. Colonoscopy performed a few months post-delivery revealed quiescent pan-colitis. Against medical advice, she discontinued medication, remained in remission and conceived within 12 months. She developed acute severe colitis in her first trimester and was managed in the same way as her first pregnancy. The remainder of her pregnancy was uneventful and she delivered at term.
She fell pregnant a third time while on azathioprine and sulphasalazine, and clinically in remission. She developed acute severe colitis in the second trimester and received her third rescue therapy with infliximab, achieved disease remission and delivered at term. Seven months later, she presented with acute severe colitis while not pregnant. She underwent total proctocolectomy with ileal J pouch anal anastomosis and has recovered well. Her three children continue to develop normally. Biological therapy is not approved as maintenance therapy for ulcerative colitis in Australia. Surgery during pregnancy is associated with risk to mother and foetus2; proctocolectomy and ileal J pouch reduces fertility and fecundity.3 This patient contributes to an increasing number of cases that support rescue infliximab as a safe therapy for fulminant colitis in pregnancy.
ACKNOWLEDGEMENT Declaration of personal and funding interests: None. REFERENCES 1. Schulze H, Esters P, Dignass A. Review article: the management of Crohn’s disease and ulcerative colitis during pregnancy and lactation. Aliment Pharmacol Ther 2014; 40: 991–1008. 2. Dozois E, Wolff B, Tremaine W, et al. Maternal and fetal outcome after colectomy for fulminant ulcerative colitis during pregnancy: case series and literature review. Dis Colon Rectum 2006; 49: 64–73. 3. Olsen K, Juul S, Berndtsson I, et al. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology 2002; 122: 15–9.
AP&T invited editorial and correspondence columns are restricted to letters discussing papers that have been published in the journal. A letter must have a maximum of 300 words, may contain one table or figure, and should have no more than 10 references. It should be submitted electronically to the Editors via http://mc.manuscriptcentral.com/apt.
ª 2015 John Wiley & Sons Ltd
325
Copyright of Alimentary Pharmacology & Therapeutics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Letters to the Editors Letter: a case supporting the use of rescue infliximab therapy for fulminant ulcerative colitis in pregnancy K. R. Forgan-Smith & J. E. Roche Department of Gastroenterology, The Townsville Hospital, Townsville, Australia. E-mail: [email protected] doi:10.1111/apt.13037
SIRS, Managing inflammatory bowel disease (IBD) during pregnancy can be challenging.1 We would like to share our experience of a patient with ulcerative colitis (UC) who experienced three severe flares, during each of her three pregnancies, that on each occasion was successfully treated with Infliximab rescue therapy. This patient was diagnosed elsewhere with mild proctitis at age twenty-two; she was not commenced on treatment. Twelve months later, she presented with acute severe colitis in the first trimester of her first pregnancy. She failed to respond to intravenous steroids. After consultation with an obstetrician and colorectal surgeon, she received rescue therapy with infliximab (0, 2 and 6 weeks); she achieved clinical remission after the first dose and was commenced on Azathioprine and Sulphasalazine. She remained in remission and delivered a healthy baby at term. Colonoscopy performed a few months post-delivery revealed quiescent pan-colitis. Against medical advice, she discontinued medication, remained in remission and conceived within 12 months. She developed acute severe colitis in her first trimester and was managed in the same way as her first pregnancy. The remainder of her pregnancy was uneventful and she delivered at term.
She fell pregnant a third time while on azathioprine and sulphasalazine, and clinically in remission. She developed acute severe colitis in the second trimester and received her third rescue therapy with infliximab, achieved disease remission and delivered at term. Seven months later, she presented with acute severe colitis while not pregnant. She underwent total proctocolectomy with ileal J pouch anal anastomosis and has recovered well. Her three children continue to develop normally. Biological therapy is not approved as maintenance therapy for ulcerative colitis in Australia. Surgery during pregnancy is associated with risk to mother and foetus2; proctocolectomy and ileal J pouch reduces fertility and fecundity.3 This patient contributes to an increasing number of cases that support rescue infliximab as a safe therapy for fulminant colitis in pregnancy.
ACKNOWLEDGEMENT Declaration of personal and funding interests: None. REFERENCES 1. Schulze H, Esters P, Dignass A. Review article: the management of Crohn’s disease and ulcerative colitis during pregnancy and lactation. Aliment Pharmacol Ther 2014; 40: 991–1008. 2. Dozois E, Wolff B, Tremaine W, et al. Maternal and fetal outcome after colectomy for fulminant ulcerative colitis during pregnancy: case series and literature review. Dis Colon Rectum 2006; 49: 64–73. 3. Olsen K, Juul S, Berndtsson I, et al. Ulcerative colitis: female fecundity before diagnosis, during disease, and after surgery compared with a population sample. Gastroenterology 2002; 122: 15–9.
AP&T invited editorial and correspondence columns are restricted to letters discussing papers that have been published in the journal. A letter must have a maximum of 300 words, may contain one table or figure, and should have no more than 10 references. It should be submitted electronically to the Editors via http://mc.manuscriptcentral.com/apt.
ª 2015 John Wiley & Sons Ltd
325
Copyright of Alimentary Pharmacology & Therapeutics is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
