High relapse rates after budesonide in microscopic colitis: a large retrospective analysis revealing the need for advanced therapies.

IF 1.2 4区医学 Q4 GASTROENTEROLOGY & HEPATOLOGY

Acta gastro-enterologica Belgica Pub Date : 2026-04-01 DOI:10.51821/89.2.15176

T Taelman, M Lenfant, S Vermeire, M Ferrante, J Sabino, B Verstockt

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引用次数: 0

Abstract

Background: Microscopic colitis (MC) is a chronic inflammatory bowel disorder causing watery diarrhea despite normal endoscopic findings. Budesonide is the only approved therapy, yet long-term durability and the need for alternatives in steroid-dependent or -refractory cases remain unclear.

Methods: We performed a retrospective single-center cohort study of all patients with histologically confirmed MC between 2013 and 2022, with ≥3 months of follow-up. Demographics, clinical features, treatments, and outcomes were collected. Clinical remission followed Hjortswang criteria: fewer than three stools per day or fewer than one watery stool per day on average.

Results: A total of 239 idiopathic MC patients met inclusion criteria. Spontaneous remission occurred in 19.2%, more often in males (OR 2.39, p=0.02). Corticosteroids, predominantly budesonide, were prescribed in 78.7% and induced remission in 75.5% within three months. Relapse affected 54.8% of responders, typically during tapering (44.6%) or shortly after cessation (55.3%). Younger age predicted relapse (OR 0.97, p=0.003). Conventional alternatives, including 5-ASA, cholestyramine, methotrexate, and azathioprine, were largely ineffective after corticosteroid failure or dependency. Advanced therapies (anti-TNF agents, vedolizumab, JAK inhibitors) were initiated in 12.6%, more often in younger patients (OR 0.95, p=0.001) and those with a family history of IBD (OR 4.11, p=0.03). These therapies achieved post-induction remission in 70% of refractory cases. Two patients required colectomy.

Conclusion: In this large cohort with long-term follow-up, budesonide remained the primary treatment, yet over half of responders relapsed during tapering or after discontinuation. Conventional alternatives showed limited benefit. Advanced therapies demonstrated meaningful effectiveness in steroid-refractory or steroid-dependent MC, underscoring the need for broader therapeutic options.

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布地奈德在显微镜下治疗结肠炎后复发率高：一项大型回顾性分析显示需要先进的治疗方法。

背景：显微镜下结肠炎（MC）是一种慢性炎症性肠道疾病，引起水样腹泻，尽管内镜检查正常。布地奈德是唯一被批准的治疗方法，但在类固醇依赖或难治性病例中，布地奈德的长期耐久性和是否需要替代药物仍不清楚。方法：我们对2013年至2022年间所有组织学证实的MC患者进行了回顾性单中心队列研究，随访≥3个月。收集了人口统计学、临床特征、治疗方法和结果。临床缓解遵循Hjortswang标准：每天少于三次大便或每天少于一次水样大便。结果：239例特发性MC患者符合纳入标准。自发性缓解发生率为19.2%，男性更为常见（OR 2.39, p=0.02）。78.7%的患者使用皮质类固醇，主要是布地奈德，75.5%的患者在3个月内获得缓解。复发影响54.8%的应答者，通常在减量期间（44.6%）或戒烟后不久（55.3%）。年龄越小预测复发（OR 0.97, p=0.003）。常规替代品，包括5-ASA、胆胺、甲氨蝶呤和硫唑嘌呤，在皮质类固醇失效或依赖后基本无效。12.6%的患者开始接受高级治疗（抗肿瘤坏死因子、维多单抗、JAK抑制剂），更常见于年轻患者（OR 0.95, p=0.001）和有IBD家族史的患者（OR 4.11, p=0.03）。这些疗法在70%的难治性病例中获得诱导后缓解。2例患者需要结肠切除术。结论：在这个长期随访的大型队列中，布地奈德仍然是主要的治疗方法，但超过一半的应答者在减量或停药后复发。传统替代方案的效果有限。先进的治疗方法在类固醇难治性或类固醇依赖性MC中显示出有意义的有效性，强调需要更广泛的治疗选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta gastro-enterologica Belgica Medicine-Gastroenterology

CiteScore

2.30

自引率

20.00%

发文量

期刊介绍： The Journal Acta Gastro-Enterologica Belgica principally publishes peer-reviewed original manuscripts, reviews, letters to editors, book reviews and guidelines in the field of clinical Gastroenterology and Hepatology, including digestive oncology, digestive pathology, as well as nutrition. Pure animal or in vitro work will not be considered for publication in the Journal. Translational research papers (including sections of animal or in vitro work) are considered by the Journal if they have a clear relationship to or relevance for clinical hepato-gastroenterology (screening, disease mechanisms and/or new therapies). Case reports and clinical images will be accepted if they represent an important contribution to the description, the pathogenesis or the treatment of a specific gastroenterology or liver problem. The language of the Journal is English. Papers from any country will be considered for publication. Manuscripts submitted to the Journal should not have been published previously (in English or any other language), nor should they be under consideration for publication elsewhere. Unsolicited papers are peer-reviewed before it is decided whether they should be accepted, rejected, or returned for revision. Manuscripts that do not meet the presentation criteria (as indicated below) will be returned to the authors. Papers that go too far beyond the scope of the journal will be also returned to the authors by the editorial board generally within 2 weeks. The Journal reserves the right to edit the language of papers accepted for publication for clarity and correctness, and to make formal changes to ensure compliance with AGEB’s style. Authors have the opportunity to review such changes in the proofs.