Real-World Effectiveness of Advanced Therapies in Microscopic Colitis

Area of Science:

• Gastroenterology
• Inflammatory Bowel Disease (IBD) research
• Clinical pharmacology

Background:

• Microscopic colitis (MC) is a primary cause of chronic diarrhoea, especially in older individuals.
• Budesonide is a common treatment, but refractory or dependent cases present significant therapeutic challenges.
• Real-world data on advanced therapies for MC are limited.

Purpose of the Study:

• To evaluate the real-world effectiveness and durability of advanced therapies in microscopic colitis patients.
• To identify predictors of treatment success in budesonide-refractory or -dependent MC.
• To compare outcomes across different advanced therapy classes.

Main Methods:

• A multinational, retrospective study using the ECCO CONFER network.
• Inclusion of MC patients treated with biologics or small molecules after budesonide failure/intolerance.
• Systematic analysis of clinical outcomes, treatment durability, and success predictors.

Main Results:

• JAK inhibitors showed the highest short-term response (95.2%) and remission (81.0%) rates, outperforming anti-TNFs, vedolizumab, and ustekinumab.
• JAK inhibitors also demonstrated superior long-term drug persistence with a lower discontinuation rate (23.8%) compared to other agents (56.3%).
• Drug class was the sole independent predictor of therapy continuation; 4.2% of patients eventually needed surgery.

Conclusions:

• Advanced therapies, particularly JAK inhibitors, are effective in the short and long term for budesonide-refractory/dependent MC.
• These findings support JAK inhibitors as a valuable option for challenging MC cases.
• The study highlights evolving treatment strategies and supports prospective trials for advanced MC therapies.