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Budesonide more effective, led to less recurrence than prednisone for microscopic colitis
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Patients with microscopic colitis treated with budesonide had better outcomes than those who received prednisone in a recent study.
Researchers performed a retrospective chart review of 80 patients with microscopic colitis (MC) who were treated with corticosteroids. Sixty-three patients were assigned budesonide (median dose 9 mg), with the remaining 17 receiving prednisone (median dose 25 mg). Response to treatment was defined as either resolution (complete response) or at least 50% improvement (partial response) to diarrhea symptoms.
Darrell S. Pardi
“Steroids are commonly used for this condition, and we wanted to see if our clinical experience paralleled that which has been reported in randomized clinical trials,” researcher Darrell S. Pardi, MD, MS, associate dean for medicine-pediatrics, at Mayo School of Graduate Medical Education in Rochester, Minn., told Healio.com. “In addition, budesonide is used much more commonly than prednisone due to fewer side effects, but it is more expensive, so we wanted to see if that extra cost is worth it.”
Overall, complete response occurred in 75.6% of cases; 20.3% of patients experienced partial response. Among prednisone recipients, 52.9% experienced full response, 41.2% partial and 5.9% no response. In the budesonide group, 82.5% had complete response, 14% partial response and 3.5% no response. Budesonide recipients were significantly more likely to experience complete response (OR=4.18; 95% CI, 1.3-13.5).
A median follow-up of 4 years was conducted for 74 evaluable patients, 71 of whom experienced partial or complete response. Recurrence occurred in 70.4% of these responders and was significantly less common among budesonide recipients (HR=0.38; 95% CI, 0.18-0.85) than prednisone patients. The median time to recurrence also was shorter among prednisone recipients (21 days vs. 63.5 days, P=.02). During 397 person-years of follow-up, maintenance therapy with corticosteroids was necessary in 64.4% of cases for which long-term data were available (73 patients).
“Steroids, particularly budesonide, work very well in microscopic colitis, but the relapse rate is high, and maintenance therapy is often needed,” Pardi said. “Budesonide is at least as good and possibly better than prednisone.”
Disclosure: See the study for a full list of relevant disclosures.
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