170 The Efficacy of Uceris in the Treatment of Microscopic and Allergic Colitides

Abstract

INTRODUCTION: Chronic non-bloody diarrhea is a common complaint seen by gastrointestinal physicians. About 10–20% of these cases are secondary to the microscopic colitides (MC), which include collagenous colitis and lymphocytic colitis, and 30% are due to allergic colitides (AC), including eosinophilic colitis and mast cell enteropathy. Entocort has previously been studied as a treatment option for MC with remission rates as high as 96%. Uceris is a budesonide formulation that does not dissolve in acid and is therefore released at a controlled rate throughout the colon. This study aimed to determine whether Uceris would provide symptomatic response in patients with MC. Additionally, this study aimed to determine whether Uceris would be effective in treating AC, which currently does not have any well-established treatment options. METHODS: This was a retrospective study using the electronic medical record (EMR) and an established database of histologic findings on biopsies obtained during colonoscopies performed at Rush University Medical Center. The EMR was used to obtain demographic data and to identify what treatment medication was used (Uceris, Entocort, H1/H2 blockers, other – anti-diarrheal and stool bulking agents). Eligible subjects were contacted by telephone and asked about symptom severity pre- and post-treatment for colitis using the Modified Harvey Bradshaw Index (MHBI, Table 1). Data was analyzed using SPSS analysis of variances. RESULTS: There were 50 subjects enrolled in this study. Demographics are listed in Table 2. The mean total MHBI score for the MC subjects was 9.75 pre-treatment with all therapeutic agents and 2.13 post-treatment, and for the AC subjects was 6.83 pre-treatment and 2.89 post-treatment. There was a greater improvement in MHBI scores in the MC group compared to the AC group (P < 0.031, F = 4.97, df = 1,48). For each treatment drug, there was an improvement in MHBI scores after therapy for both MC and AC (Table 3). CONCLUSION: For subjects with MC, there was greater improvement in MHBI scores with Entocort. However, the mean MHBI pre-treatment scores for MC subjects were greatest in those treated with Uceris. It is possible that Uceris was reserved for subjects with more significant symptoms or for those who failed treatment with other agents. There was a greater improvement in MHBI scores in subjects with AC that received Entocort and Uceris, suggesting that steroids may be helpful in controlling symptoms. This study was limited by small sample size and recall bias.