Real-World Effectiveness of Advanced Therapies in Microscopic Colitis.
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Verstockt Bram, Taelman Thibault, Din Shahida, Vavricka Stephan R, Blesl Andreas, Zabana Yamile, Van Moerkercke Wouter, Kiudelis Vytautas, de la Revilla Negro Juan, Maillard Michel H, Savarino Edoardo Vincenzo, Teich Niels, Macaigne Gilles, Truyens Marie, Ribaldone Davide Giuseppe, Barreiro-de Acosta Manuel, Wildt Signe, Rivière Pauline, Fumery Mathurin, Amiot Aurélien, Marsal Jan, Tontini Gian Eugenio, Levartovsky Asaf, Vieujean Sophie, Somers Michael, Cremer Anneline, Lutakov Ivan, Cohen Nathaniel A, Dewit Sophie, Bajer Lukas, Rahier Jean-Francois, Backman Ann-Sofie, Nancey Stephane, Choden Tenzin, Van Dongen Jurgen, Rogler Gerhard, Lenfant Matthias, Finlayson Mhairi, Münch Andreas, Julsgaard Mette
Аннотация
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.