Colon to Rectum
J Crohns Colitis. 2022;16(12):1816–24
Biologic therapy for budesonide-refractory, -dependent or -intolerant microscopic colitis: A multicenter cohort study from the GETAID
Background: Budesonide remains the backbone therapy for microscopic colitis (MC); however, relapses are frequent, and some patients are intolerant or dependent. Anti-tumor necrosis factor (TNF) therapy is increasingly used to treat these patients, but available evidence is still limited. The aim of this study was to evaluate the effectiveness and safety of anti-TNF therapy in MC patients failing budesonide.
Methods: In a multicenter retrospective cohort study, budesonide-refractory, -dependent, or -intolerant MC patients treated with anti-TNF agents were included. Clinical remission was defined as fewer than 3 bowel movements per day, and clinical response was defined as an improvement in stool frequency of at least 50%.
Results: 14 patients were included. Median age was 58.5 years, median disease duration was 25 months, and median follow-up was 29.5 months. Seven patients were treated with infliximab (IFX), and 7 with adalimumab. Clinical remission without steroids at 12 weeks was reached in 5 of 14 patients (35.7%); all of these received IFX. Clinical response at 12 and 52 weeks, was obtained in 9 of 14 patients (64.3%) and 7 of 14 patients (50%), respectively. Five patients switched to another anti-TNF agent. When considering both first- and second-line anti-TNF therapies, 7 patients (50%) were in clinical remission at week 52. Mild-to-moderate adverse events were reported in 6 patients. Two patients were treated with vedolizumab, of whom 1 had clinical response; 1 patient treated with ustekinumab had no response.
Conclusions: This is the first multicenter cohort study showing that half of patients treated with anti-tumor necrosis factor therapy for microscopic colitis achieved clinical remission in case of budesonide failure.