Ciclosporin effectively resolves steroid-refractory ocrelizumab-induced colitis in a woman with MS.

Multiple sclerosis (MS) treatment often involves anti-CD20 monoclonal antibodies like ocrelizumab, which deplete B cells. A rare but severe complication is ocrelizumab-induced colitis, a condition that can necessitate life-saving surgery if not promptly managed. Diagnosis is challenging, requiring exclusion of infective colitis or classical inflammatory bowel disease (IBD). The prolonged B-cell depletion by ocrelizumab complicates the clinical picture, and a lack of comprehensive data makes acute medical management particularly difficult for this specific adverse event.

This case report details the clinical course of a woman with multiple sclerosis who developed steroid-refractory ocrelizumab-induced colitis. Following the failure of standard corticosteroid therapy, the patient was initiated on ciclosporin therapy as a salvage treatment. The protocol involved careful titration of ciclosporin while closely monitoring therapeutic drug levels to ensure efficacy and minimize toxicity. Additionally, vigilance for neurotoxicity was maintained, and early multidisciplinary team involvement was crucial for safe management throughout the treatment period.

Ciclosporin therapy proved to be an effective salvage treatment for the patient's steroid-refractory ocrelizumab-induced colitis. The abstract explicitly states that the condition was "managed effectively with ciclosporin therapy." This positive outcome was achieved despite the colitis being refractory to initial steroid treatment, indicating a significant therapeutic response to ciclosporin. The successful management was further supported by a structured approach involving:

Careful monitoring of therapeutic drug levels and vigilant assessment for neurotoxicity, which facilitated the safe titration of ciclosporin and optimized patient outcomes. This comprehensive approach, coupled with early multidisciplinary team involvement, was key to navigating the complexities of this rare and severe adverse event.