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Real-world Effectiveness of Advanced Therapies in Microscopic Colitis.

Bram Verstockt1, Thibault Taelman2, Shahida Din3

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Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association
|December 28, 2025
PubMed
Summary

Advanced therapies, especially JAK inhibitors, show significant effectiveness for refractory microscopic colitis (MC) patients who failed budesonide. These treatments offer promising short- and long-term outcomes, improving therapeutic options for chronic diarrhoea.

Keywords:
Advanced TherapyBiologicsCollagenous ColitisJAK InhibitorLymphocytic ColitisMicroscopic ColitisSmall Molecules

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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.