Am J Gastroenterol. 2022 Apr 13. doi: 10.14309/ajg.0000000000001774. Online ahead of print.
ABSTRACT
INTRODUCTION: Outcomes and safety of budesonide maintenance therapy in microscopic colitis (MC) are not well known.
METHODS: Adult residents of Olmsted County, Minnesota diagnosed with MC (2002-2019) and treated with budesonide were identified using the Rochester Epidemiology Project. Response was assessed at 12 +/- 4 weeks after initiation of therapy and defined as complete (resolution of diarrhea), partial (≥50% improvement in number of bowel movements), nonresponse (<50% improvement), and intolerance (discontinued due to side-effects). For safety outcomes, cases (budesonide maintenance) and MC controls (no budesonide therapy) were matched by gender and age at diagnosis (+/-2 years).
RESULTS: A total of 450 patients were identified, of which 162 (36.0%) were treated with budesonide for induction of clinical remission [median age 67 (23-91) years and 126 (77.8%) female]. Clinical outcomes for induction were as follows: 130 (80.2%) complete response, 22 (13.6%) partial response, 8 (4.9%) no response, and 2 (1.2%) intolerance. After induction, 96 (63.2%) had recurrence after discontinuation; 27 (28.1%) required further budesonide induction treatment without maintenance, 56 (58.3%) required long-term budesonide maintenance, and 13 (13.5%) were treated with other therapies. Of those receiving budesonide maintenance, all responded [55 (98.2%) complete, 1 (1.8%) partial]. No patient stopped maintenance from adverse events. The median duration of follow-up was 5.6 years (0.3-18.9). There was no significant difference between cases and controls in the incidence of osteopenia/ osteoporosis, diabetes mellitus, hypertension, glaucoma, or cataracts.
CONCLUSION: The long-term use of budesonide in MC appears to be effective and generally well tolerated with limited adverse effects.
PMID:35417427 | DOI:10.14309/ajg.0000000000001774
