P591 Treatment of microscopic colitis: retrospective analysis of consecutive single centre patients

Abstract

Abstract Background Microscopic colitis (MC) is a chronic autoimmune inflammatory condition of the colon that causes watery diarrhoea along with other symptoms like bowel incontinence. MC is a benign condition with no increase in cancer risk or impact on survival but it usually requires treatment due to significantly impaired quality of life. Even though MC therapy is symptom oriented, recent studies have shown that almost half the patients require long-term medical treatment. Methods A retrospective analysis of consecutive MC patients treated in Lithuanian University of Health Sciences Hospital Kauno Klinikos over the last 6 years was performed. Patient characteristics and clinical information was obtained from electronic records. Results 94 MC patients were treated in our centre since 2017, 46 (49 %) with collagenous colitis (CC), 39 (41.5 %) with lymphocytic colitis (LC), 2 (2.1 %) with incomplete CC and 7 (7.4 %) with incomplete LC. 77 patients were female (82 %). Median age was 59 years [44.8-70.3]. There was a tendency for men to be younger (median 42 [37-68]) than women (median 60 [50-70.5]) but not significantly (p>0.05). During the 6-year period 67 patients (71.3 %) were treated with budesonide, 33 (35.1 %) received only one course and went into clinical remission while 34 (36.2 %) needed either multiple courses or continuous treatment for relapsing or chronic active disease respectively. Primary non-response to budesonide wasn’t documented in any patient. 8 patients (8.5 %) were treated with azathioprine due to budesonide dependency or intolerance but it was discontinued in all but 1 patient due to lack of response or adverse events. 3 patients (3.2 %) were treated with biological therapy. 1 patient was treated with adalimumab which was discontinued due to adverse events, 1 was treated with infliximab which was switched to vedolizumab due to loss of response, and 1 was treated with vedolizumab which was switched to adalimumab due to primary non-response. At the time of analysis 61 patients (64.9 %) were receiving no active treatment, 21 (22.3 %) were receiving intermittent courses of budesonide, 6 (6.4 %) had been prescribed budesonide on demand, 3 (3.2 %) were taking budesonide continuously, 1 (1.1 %) was taking azathioprine and 2 (2.1 %) were on biological therapy. There was no difference between CC and LC patients.Conclusion A little less than half of the patients needed long-term medical treatment. While budesonide was widely used and usually effective, we observed a need for advanced therapies as well.