Real-world effectiveness of advanced therapies in microscopic colitis.
(2025) Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological — (2025)
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- 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. 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. 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. 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.
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Verstockt, B., Taelman, T., Din, S., Vavricka, S. R., Blesl, A., Zabana, Y., Van Moerkercke, W., Kiudelis, V., de la Revilla Negro, J., Maillard, M. H., Savarino, E. V., Teich, N., Macaigne, G., Truyens, M., Ribaldone, D. G., Barreiro-de Acosta, M., Wildt, S., Rivière, P., Fumery, M., et al. (2025). Real-world effectiveness of advanced therapies in microscopic colitis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological. Accepted/in-press. https://doi.org/10.1016/j.cgh.2025.12.019 (Original work published 2025)