Collagenous colitis: Requirement for high-dose budesonide as maintenance treatment. Issue 9 (September 2017)

• Record Type: Journal Article
• Authors: Fernandez-Bañares, Fernando; Piqueras, Marta; Guagnozzi, Danila; Robles, Virginia; Ruiz-Cerulla, Alexandra; Casanova, María José; Gisbert, Javier P.; Busquets, David; Arguedas, Yolanda; Pérez-Aisa, Angeles; Fernández-Salazar, Luis; Lucendo, Alfredo J.
• Is Part Of: Digestive and liver disease. Volume 49:Issue 9(2017)
• Page Start: 973
• Page End: 977
• Publication Date: 2017-09
• Subjects: Azathioprine -- Budesonide -- Collagenous colitis -- Maintenance therapy; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2017.03.026
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: Controlled studies show high efficacy of budesonide in inducing short-term clinical remission in collagenous colitis (CC), but relapses are common after its withdrawal. Aim: To evaluate the need for high-dose budesonide (≥6 mg/d) to maintain clinical remission in CC. Methods: Analysis of a multicentre retrospective cohort of 75 patients with CC (62.3 ± 1.5 years; 85% women) treated with budesonide in a clinical practice setting between 2013 and 2015. Frequency of budesonide (9 mg/d) refractoriness and safety, and the need for high-dose budesonide to maintain clinical remission, were evaluated. Drugs used as budesonide-sparing, including azathioprine and mercaptopurine, were recorded. Logistic regression analysis was performed to evaluate the risk factors associated with the need for high-dose budesonide (≥6 mg/d) to maintain clinical remission. Results: Budesonide induced clinical remission in 92% of patients, with good tolerance. Fourteen of 68 patients (21%; 95% CI, 13–32%) needed high-dose budesonide to maintain remission. Only intake of NSAIDs at diagnosis (OR, 8.6; 95% CI, 1.6–44) was associated with the need for high-dose budesonide in the multivariate analysis. Treatment: with thiopurines was effective in 5 out of 6 patients (83%; 95% CI, 44–97%), allowing for withdrawal from or a dose decrease of budesonide. Conclusions: One fifth of CC patients, especially those with NSAID intake at diagnosis, require high-dose budesonide (≥6 mg/d) to maintain clinical remission. In this setting, thiopurines might be effective as budesonide-sparing drugs.