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Real-world Effectiveness of Advanced Therapies in Microscopic Colitis

Verstockt, Bram ; Taelman, Thibault ; Din, Shahida ; Vavricka, Stephan R. ; Blesl, Andreas ; Zabana, Yamile ; Van Moerkercke, Wouter ; Kiudelis, Vytautas ; de la Revilla Negro, Juan and Maillard, Michel H. , et al. (2026) In Clinical Gastroenterology and Hepatology
Abstract

Background & Aims Microscopic colitis (MC) is a leading cause of chronic diarrhea, particularly in older adults. Although many patients respond to budesonide, refractory and dependent cases pose major therapeutic challenges. Although the off-label use of advanced inflammatory bowel disease therapies is expanding, robust real-world data remain scarce. Methods Through the ECCO CONFER network, we conducted a multinational, retrospective study in patients with MC 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-tumor necrosis factor (TNF)... (More)

Background & Aims Microscopic colitis (MC) is a leading cause of chronic diarrhea, particularly in older adults. Although many patients respond to budesonide, refractory and dependent cases pose major therapeutic challenges. Although the off-label use of advanced inflammatory bowel disease therapies is expanding, robust real-world data remain scarce. Methods Through the ECCO CONFER network, we conducted a multinational, retrospective study in patients with MC 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-tumor necrosis factor (TNF) agents were most frequently initiated (55.9%), followed by vedolizumab (28.8%) and Janus kinase (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 < .01). Long-term drug persistence mirrored these findings: JAK inhibitors demonstrated a markedly lower discontinuation rate (23.8%) compared with other agents (56.3%; odds ratio, 5.07; 95% confidence interval, 1.52–16.9; P = .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. Conclusions 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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organization
publishing date
type
Contribution to journal
publication status
in press
subject
keywords
Advanced Therapy, Biologics, Collagenous Colitis, JAK Inhibitor, Lymphocytic Colitis, Microscopic Colitis, Small Molecules
in
Clinical Gastroenterology and Hepatology
publisher
Elsevier
external identifiers
  • scopus:105034414998
  • pmid:41456829
ISSN
1542-3565
DOI
10.1016/j.cgh.2025.12.019
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 American Gastroenterological Association Institute.
id
4e8f3f2a-a62a-4f2f-bfbc-5022242f5171
date added to LUP
2026-05-25 13:22:50
date last changed
2026-05-25 13:50:14
@article{4e8f3f2a-a62a-4f2f-bfbc-5022242f5171,
  abstract     = {{<p>Background &amp; Aims Microscopic colitis (MC) is a leading cause of chronic diarrhea, particularly in older adults. Although many patients respond to budesonide, refractory and dependent cases pose major therapeutic challenges. Although the off-label use of advanced inflammatory bowel disease therapies is expanding, robust real-world data remain scarce. Methods Through the ECCO CONFER network, we conducted a multinational, retrospective study in patients with MC 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-tumor necrosis factor (TNF) agents were most frequently initiated (55.9%), followed by vedolizumab (28.8%) and Janus kinase (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 &lt; .01). Long-term drug persistence mirrored these findings: JAK inhibitors demonstrated a markedly lower discontinuation rate (23.8%) compared with other agents (56.3%; odds ratio, 5.07; 95% confidence interval, 1.52–16.9; P = .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. Conclusions 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.</p>}},
  author       = {{Verstockt, Bram and Taelman, Thibault and Din, Shahida and Vavricka, Stephan R. and Blesl, Andreas and Zabana, Yamile and Van Moerkercke, Wouter and Kiudelis, Vytautas and de la Revilla Negro, Juan and Maillard, Michel H. and Savarino, Edoardo Vincenzo and Teich, Niels and Macaigne, Gilles and Truyens, Marie and Ribaldone, Davide Giuseppe and Barreiro-de Acosta, Manuel and Wildt, Signe and Rivière, Pauline and Fumery, Mathurin and Amiot, Aurélien and Marsal, Jan and Tontini, Gian Eugenio and Levartovsky, Asaf and Vieujean, Sophie and Somers, Michael and Cremer, Anneline and Lutakov, Ivan and Cohen, Nathaniel A. and Dewit, Sophie and Bajer, Lukas and Rahier, Jean Francois and Backman, Ann Sofie and Nancey, Stephane and Choden, Tenzin and Van Dongen, Jurgen and Rogler, Gerhard and Lenfant, Matthias and Finlayson, Mhairi and Münch, Andreas and Julsgaard, Mette}},
  issn         = {{1542-3565}},
  keywords     = {{Advanced Therapy; Biologics; Collagenous Colitis; JAK Inhibitor; Lymphocytic Colitis; Microscopic Colitis; Small Molecules}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Clinical Gastroenterology and Hepatology}},
  title        = {{Real-world Effectiveness of Advanced Therapies in Microscopic Colitis}},
  url          = {{http://dx.doi.org/10.1016/j.cgh.2025.12.019}},
  doi          = {{10.1016/j.cgh.2025.12.019}},
  year         = {{2026}},
}