***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Introduction : Refractory coeliac disease ( RCD ) is a rare syndrome with a poor prognosis , defined by malabsorption due to gluten‐related enteropathy after initial or subsequent failure of a strict gluten‐free diet and after exclusion of any disorder mimicking coeliac disease OBJECTIVE : Refractory sprue is a rare and severe malabsorptive disorder that mimics celiac disease but is refractory to a gluten-free diet and is without initial evidence of overt lymphoma . Treatment is largely empiric and often ineffective , with steroids and immunosuppression being the mainstream therapeutic options . The aim of this study was to evaluate prospect ively the effect of azathioprine on a group of patients diagnosed with refractory sprue . METHODS : We studied seven consecutive patients ( five women and two men ) with a well-defined diagnosis of refractory sprue and a lack of response to oral or parenteral steroids . At diagnosis , five patients had endoscopic evidence of ulcerative jejunitis , and five underwent exploratory laparotomy for exclusion of malignancies . The characteristic monoclonal TCRγ gene rearrangement was shown in five of six patients studied . Patients were treated for a mean of 11 months ( range 8–12 months ) , and clinical , biochemical , molecular , and histological parameters were reassessed at the end of the trial . The study was a prospect i ve , open-label , non-placebo-controlled study using azathioprine ( 2 mg/kg/day ) plus oral prednisone ( 1 mg/kg/day ) . A gluten-free diet ( n = 7 ) as well as enteral ( n = 6 ) and parenteral nutrition ( n = 5 ) were administered during the trial . RESULTS : After treatment , five patients had a complete clinical remission , and biochemical and nutritional parameters were significantly improved . Steroids were tapered after the onset of azathioprine , and no patient was on steroids at the end of the trial . Intestinal histology improved significantly in all cases ( normal histology in three cases and minor infiltration in the lamina propria in two ) . Two patients did not respond to treatment at any time and died in months 10 and 9 , of an irreversible ventricular fibrillation and sepsis , respectively . No overt lymphoma was demonstrated during the follow-up . CONCLUSIONS : The present study confirms earlier anecdotal reports on the efficacy of azathioprine in refractory sprue , with clear clinical and histological improvement shown in most patients . However , monoclonality persisted after treatment . We consider that a larger number of patients should be evaluated before a definitive recommendation is adopted for use of this drug in refractory sprue AIM To evaluate cladribine [ 2-chlorodeoxyadenosine ( 2-CdA ) ] therapy in refractory celiac disease ( RCD ) II . METHODS An open-label cohort- study of RCD II patients treated with 2-CdA was performed between 2000 and 2010 .  Survival rate , enteropathy associated T-cell lymphoma ( EATL ) occurrence , clinical course , and histological and immunological response rates were evaluated . RESULTS Overall , 32 patients were included with a median follow-up of 31 mo . Eighteen patients responded well to 2-CdA. Patients responsive to 2-CdA had a statistically significant increased survival compared to those who were unresponsive . The overall 3- and 5-year survival was 83 % in the responder and 63 % and 22 % in the non-responder group , respectively . The overall 2-year clinical , histological and immunological response rates were 81 % , 47 % and 41 % , respectively . Progression into EATL was reported in 16 % , all of these patients died . CONCLUSION Treatment of RCD II with 2-CdA holds promise , showing excellent clinical and histological response rates , and probably less frequent transition into EATL BACKGROUND & AIMS Refractory celiac disease ( RCD ) may be subdivided into RCD types I and II with phenotypically normal and aberrant intraepithelial T-cell population s , respectively . In RCD II , transition into enteropathy-associated T-cell lymphoma ( EATL ) is seen frequently . We have evaluated the effect of cladribine ( 2-CDA ) , a purine analogue inducing T-cell depletion , on clinical , histopathologic , and immunologic parameters , as well as the toxicity and side effects in a group of RCD II patients . METHODS Between 2000 and 2005 , 17 patients were included ( 8 men , 9 women ) . All patients had a clonal rearrangement of the T-cell receptor gamma gene and immunophenotyping showed an aberrant T-cell population lacking surface expression of CD3 , CD8 , and T-cell receptor alphabeta , in the presence of expression of surface CD103 and intracytoplasmic CD3 . Treatment consisted of 2-CDA ( 0.1 mg/kg/day ) intravenously for 5 days , given in 1 - 3 courses every 6 months depending on the response . RESULTS All patients tolerated 2-CDA without serious side effects . Six patients ( 35.8 % ) showed a clinical improvement ( weight gain , improvement of diarrhea , and hypoalbuminemia ) . In 10 patients ( 58.8 % ) a significant histologic improvement and in 6 patients ( 35.2 % ) a significant decrease in aberrant T cells was seen . Seven patients ( 41.1 % ) developed EATL and died subsequently . One patient died of progressive refractory state with emaciation . CONCLUSIONS Treatment with 2-CDA in RCD II is feasible , well tolerated , and can induce clinical and histologic improvement as well as a significant decrease of aberrant T cells in a subgroup of patients , albeit it does not prevent EATL development . However , the earlier reported potential risk of precipitating an overt lymphoma should be taken into consideration OBJECTIVE To compare the efficacy , safety , and tolerability of 5 doses of oral tofacitinib ( CP-690,550 ) or adalimumab monotherapy with placebo for the treatment of active rheumatoid arthritis ( RA ) in patients with an inadequate response to disease-modifying antirheumatic drugs . METHODS In this 24-week , double-blind , phase IIb study , patients with RA ( n = 384 ) were r and omized to receive placebo , tofacitinib at 1 , 3 , 5 , 10 , or 15 mg administered orally twice a day , or adalimumab at 40 mg injected subcutaneously every 2 weeks ( total of 6 injections ) followed by oral tofacitinib at 5 mg twice a day for 12 weeks . The primary end point was the responder rate according to the American College of Rheumatology 20 % improvement criteria ( ACR20 ) at week 12 . RESULTS Treatment with tofacitinib at a dose of ≥3 mg twice a day result ed in a rapid response with significant efficacy when compared to placebo , as indicated by the primary end point ( ACR20 response at week 12 ) , achieved in 39.2 % ( 3 mg ; P ≤ 0.05 ) , 59.2 % ( 5 mg ; P < 0.0001 ) , 70.5 % ( 10 mg ; P < 0.0001 ) , and 71.9 % ( 15 mg ; P < 0.0001 ) in the tofacitinib group and 35.9 % of patients in the adalimumab group ( P = 0.105 ) , compared with 22.0 % of patients receiving placebo . Improvements were sustained at week 24 , according to the ACR20 , ACR50 , and ACR70 response rates as well as classifications of remission according to the 3-variable Disease Activity Score in 28 joints ( DAS28 ) using C-reactive protein and the 4-variable DAS28 using the erythrocyte sedimentation rate . The most common treatment-emergent adverse events ( AEs ) in patients across all tofacitinib treatment arms ( n = 272 ) were urinary tract infection ( 7.7 % ) , diarrhea ( 4.8 % ) , headache ( 4.8 % ) , and bronchitis ( 4.8 % ) . CONCLUSION Tofacitinib monotherapy at ≥3 mg twice a day was efficacious in the treatment of patients with active RA over 24 weeks and demonstrated a manageable safety profile OBJECTIVE : Corticosteroids are used in patients with refractory celiac disease . In order to minimize their systemic side effects , we assessed the role of a locally active sustained release corticosteroid with minimal systemic bioavailability in patients with refractory celiac disease in an open labeled noncontrolled study . METHODS : Patients who received budesonide for refractory celiac disease were classified according to whether they were primarily or secondarily unresponsive to the diet , and whether they had a polyclonal ( type I ) or clonal ( type II ) expansion of intraepithelial lymphocytes . The response to budesonide was assessed globally and by reduction in bowel movements . RESULTS : Patients ( N = 29 , 72 % female ) received budesonide for a mean of 6.7 ± 8.5 months , 5 patients ( 18 % ) had type II disease ( clonal T-cell population ) ; 76 % responded to the medication , 55 % completely . Response occurred when budesonide was used alone or with oral corticosteroids and /or azathioprine . There was an objective improvement in the number of bowel movements in those that responded . Response occurred in those with either primary or secondary refractory disease and in those with type II disease , irrespective of the presence of microscopic colitis ( N = 7 ) . There was no improvement in the duodenal biopsy over the study period and there were no side effects  of budesonide . CONCLUSIONS : Budesonide may be of value in the management of refractory celiac disease Autologous hematopoietic stem cell transplantation ( ASCT ) is an increasingly accepted treatment for refractory autoimmune diseases . Refractory celiac disease with aberrant T cells ( RCD type II ) is unresponsive to available therapies and carries a high risk of transition into enteropathy associated T-cell lymphoma ( EATL ) . This study reports on the feasibility , safety , and efficacy of ASCT in patients with RCD type II . Thirteen patients with RCD type II were evaluated . Seven patients ( 4 men , 3 women , mean age 61.5 years [ range , 51 - 69 years ] ) underwent transplantation .  After conditioning with fludarabine and melphalan , ASCT was performed . Patients were monitored for response , adverse effects , and hematopoietic reconstitution . All 7 patients completed the mobilization and leukapheresis procedures successfully and subsequently underwent conditioning and transplantation .  Engraftment occurred in all patients . No major nonhematologic toxicity or transplantation-related mortality was observed . There was a significant reduction in the aberrant T cells in duodenal biopsies associated with improvement in clinical well-being and normalization of hematologic and biochemical markers ( mean follow-up , 15.5 months ; range , 7 - 30 months ) . One patient died 8 months after transplantation from progressive neuroceliac disease . These preliminary results showed that high-dose chemotherapy followed by ASCT seems feasible and safe and might result in long-term improvement of patients with RCD type II whose condition did not respond promptly to available drugs Autologous hematopoietic SCT ( auto-SCT ) has been effective therapy for refractory disease , in both malignancies and severe autoimmune diseases . It seems feasible and safe for refractory celiac disease ( RCD ) type II , although long-term results have not been evaluated yet . With current therapies , progression into enteropathy-associated T-cell lymphoma ( EATL ) occurs in 60–80 % patients , with a high mortality rate . Therefore , it is important to evaluate new treatment strategies . Between March 2004 and February 2010 , 18 RCD II patients were evaluated for auto-SCT  preceded by conditioning with fludarabine and melphalan , as a consequence of unresponsiveness to cladribine therapy .  Adverse events , survival rate , EATL development and change in clinical , histological and immunological course were monitored . Thirteen patients were transplanted successfully and followed up for > 2 years , 4-year survival rate was 66 % . Only one patient died because of transplant-related complications . The majority of patients showed an impressive clinical improvement and five a complete histological remission . In five patients , auto-SCT could not be performed ; they all died with a median survival of 5.5 months . EATL was observed in one transplanted patient , only after 4 years of follow-up . Auto-SCT after conditioning with high-dose chemotherapy in RCD II patients unresponsive to cladribine therapy is feasible and seems promising Refractory coeliac disease ( RCD ) is a rare diagnosis made after the exclusion of any disorder mimicking CD and after initial or subsequent failure of a strict gluten-free diet ( GFD ) to restore normal intestinal architecture . In the past , treatments such as steroids , cyclosporin and azathioprine have been tried , but literature on this subject consists mainly of case reports . Interleukin-10 ( IL-10 ) may be beneficial in RCD because of its inhibitory effect on T-ly 
    Output:
    
RCD is a very rare disease .
The current evidence for RCDI treatment includes prednisolone in combination with the immunosuppressants azathioprine , mesalamine or tioguanine .