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AGA guideline recommends budesonide induction therapy for symptomatic microscopic colitis
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The AGA recently released a new guideline on the medical management of microscopic colitis, which strongly recommends budesonide induction therapy for patients with symptomatic microscopic colitis, and maintenance therapy in appropriate cases.
“Microscopic colitis is not associated with increased mortality, although symptoms can lead to impaired quality of life,” the guideline authors wrote. “Unlike other inflammatory colitides, there is no evidence that the persistence of histological inflammation portends long-term unfavorable outcomes such as colorectal cancer or need for surgery. Accordingly, the goal of medical therapy reflected in these recommendations is to relieve symptoms and improve quality of life while minimizing drug-related adverse effects.”
Using the Institute of Medicine’s best practices and Grading of Recommendations Assessment, Development and Evaluation approach, the AGA Clinical Guidelines Committee developed nine recommendations for the medical management of microscopic colitis.
Budesonide is strongly recommended for induction of clinical remission in symptomatic patients over no treatment or mesalamine, unless budesonide is not feasible, in which case mesalamine, bismuth salicylate or prednisolone/prednisone is suggested. The committee also suggests mesalamine monotherapy should be used for induction rather than combination therapy with cholestyramine and mesalamine, and suggests against induction therapy with Boswellia serrata or probiotics. Finally, the committee recommends budesonide maintenance therapy for patients with recurrent symptoms after stopping induction therapy.
“The weight of evidence supports the first-line use of budesonide for induction and, when appropriate, maintenance therapy,” the authors concluded. “Because the technical review and guideline focused on treatments assessed in clinical trials, it did not address the full armamentarium of therapies currently used in practice. We would endorse clinical trials that more rigorously assess the effectiveness of lower-cost alternatives such as antidiarrheal agents (eg, loperamide) and cholestyramine monotherapy with accompanying cost-effective analyses.” – by Adam Leitenberger
Disclosures: Healio Gastroenterology could not confirm relevant financial disclosures at the time of publication.
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