Biologic Therapy for Budesonide-refractory, -dependent or -intolerant Microscopic Colitis: a Multicentre Cohort Study...

Area of Science:

• Gastroenterology
• Immunology
• Pharmacology

Background:

• Microscopic colitis (MC) management often relies on budesonide, but frequent relapses and intolerance necessitate alternative treatments.
• Anti-tumor necrosis factor (anti-TNF) therapy is emerging for budesonide-refractory MC, yet evidence remains limited.

Purpose of the Study:

• To evaluate the effectiveness and safety of anti-TNF therapy in microscopic colitis patients who have failed budesonide treatment.

Main Methods:

• A multicenter retrospective cohort study included MC patients refractory to, dependent on, or intolerant of budesonide, treated with anti-TNF agents.
• Clinical remission was defined as fewer than three bowel movements daily; clinical response was defined as at least a 50% improvement in stool frequency.

Main Results:

• Of 14 patients, 35.7% achieved steroid-free clinical remission at 12 weeks, with all responders receiving infliximab.
• Overall, 50% of patients achieved clinical remission at 52 weeks, considering both first- and second-line anti-TNF therapies.
• Mild to moderate adverse events were reported in six patients; vedolizumab and ustekinumab showed limited response in this cohort.

Conclusions:

• This study is the first multicenter cohort demonstrating that anti-TNF therapy can induce clinical remission in 50% of microscopic colitis patients with prior budesonide failure.
• Anti-TNF agents represent a significant therapeutic option for patients with refractory or intolerant microscopic colitis.