Clin Gastroenterol Hepatol. 2025 Dec 26:S1542-3565(25)01066-3. doi: 10.1016/j.cgh.2025.12.019. Online ahead of print.
ABSTRACT
BACKGROUND AND AIMS: Microscopic colitis (MC) is a leading cause of chronic diarrhoea, particularly in older adults. While many patients respond to budesonide, refractory and dependent cases pose major therapeutic challenges. Although the off-label use of advanced IBD therapies is expanding, robust real-world data remain scarce.
METHODS: Through the ECCO CONFER network, we conducted a multinational, retrospective study in MC patients treated with biologics or small molecules following budesonide failure or intolerance. We systematically analyzed clinical outcomes, treatment durability, and predictors of therapeutic success.
RESULTS: Among 229 treatment cycles in 142 patients, anti-TNF agents were most frequently initiated (55.9%), followed by vedolizumab (28.8%) and JAK inhibitors (9.2%). Short-term clinical response and remission rates were highest with JAK inhibitors (95.2% and 81.0%, respectively), significantly outperforming anti-TNFs, vedolizumab, and ustekinumab (p<0.01). Long-term drug persistence mirrored these findings: JAK inhibitors demonstrated a markedly lower discontinuation rate (23.8%) compared to other agents (56.3%, OR 5.07, 95% CI 1.52-16.9, p = 0.008). Multivariate analysis confirmed drug class as the only independent predictor of therapy continuation. Despite advanced therapies, 4.2% of patients ultimately required surgical intervention.
CONCLUSION: This real-world study demonstrates the promising short- and long-term effectiveness of advanced therapies-particularly JAK inhibitors-in budesonide-refractory and budesonide-dependent MC. These findings pave the way for dedicated prospective trials and highlight evolving therapeutic strategies in MC.
PMID:41456829 | DOI:10.1016/j.cgh.2025.12.019