Ulcerative Colitis Clinical Case Review

Bharati Kochar, MD, MS, an IBD specialist at Massachusetts General Hospital and Harvard Medical School, discussed the results after treatment for the case.

About 1 month after discharge, the patient “was doing well,” and experiencing one to three formed bowel movements each day with no blood, according to Kochar, who was then able to lower the dose of steroids by 1 mg per week.

The patient was off steroids a few months later, was experiencing one formed bowel movement without blood each day, had normal hemoglobin and C-Reactive protein levels and a fecal calprotectin of 200 mcg/g.

Months later, the patient continued to feel well.

About 9 months after beginning treatment with tofacitinib, the patient was scoped, which revealed endoscopic remission with minimal histologic activity. As a result, steroid treatment was de-escalated.

Kochar said that she followed the patient over the next year, at which time she rescoped the patient and determined that she was in histologic remission.

After an extensive conversation with the patient, they agreed together to discontinue tofacitinib, and “she continues to remain asymptomatic on vedolizumab every 4 weeks, including during her last visit with us last month,” Kochar said.

Kochar noted that the biggest takeaways from this case are to continually read and learn, and
“partner with patients to consider their preferences.”