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Outcomes of patients with microscopic colitis treated with corticosteroids: a population-based study.

AbstractOBJECTIVES:
To evaluate the outcomes of corticosteroid-treated microscopic colitis (MC) in a population-based cohort, and to compare these outcomes in patients treated with prednisone or budesonide.
METHODS:
A historical cohort study of Olmsted County, Minnesota residents diagnosed with collagenous or lymphocytic colitis (LC) between 1986 and 2010 was performed using the Rochester Epidemiology Project.
RESULTS:
Of 315 patients with MC, 80 (25.4%) were treated with corticosteroids. The median age at colitis diagnosis was 66.5 years (range: 16-95) and 78.7% were female. Forty patients (50%) had LC and 40 (50%) had collagenous colitis. Prednisone was used in 17 patients (21.2%) and budesonide in 63 (78.8%); 56 (75.6%) had complete response and 15 (20.3%) had partial response. Patients treated with budesonide had a higher rate of complete response than those treated with prednisone (82.5 vs. 52.9%; odds ratio, 4.18; 95% CI, 1.3-13.5). Six patients were lost to follow-up. The remaining 74 had a median follow-up of 4 years (range 0.2-14). Fifty patients out of the 71 who responded (70.4%) had a recurrence after corticosteroid discontinuation. Patients treated with budesonide were less likely to recur than those treated with prednisone (hazard ratio, 0.38; 95% CI, 0.18-0.85; P=0.02). After 397 person years of follow-up in the 73 patients with long-term data, 47 (64.4%) required maintenance with corticosteroids.
CONCLUSION:
Patients with MC often respond to corticosteroid therapy, but with a high relapse rate. Budesonide had a higher response rate and a lower risk of recurrence than prednisone.
AuthorsNicole M Gentile, Adil A Abdalla, Sahil Khanna, Thomas C Smyrk, William J Tremaine, William A Faubion, Patricia P Kammer, William J Sandborn, Edward V Loftus Jr, Darrell S Pardi
JournalThe American journal of gastroenterology (Am J Gastroenterol) Vol. 108 Issue 2 Pg. 256-9 (Feb 2013) ISSN: 1572-0241 [Electronic] United States
PMID23295275 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural)
Chemical References
  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents
  • Gastrointestinal Agents
  • Budesonide
  • Prednisone
Topics
  • Adolescent
  • Adrenal Cortex Hormones (therapeutic use)
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Inflammatory Agents (therapeutic use)
  • Budesonide (therapeutic use)
  • Chronic Disease
  • Cohort Studies
  • Colitis, Microscopic (drug therapy, epidemiology, pathology, prevention & control)
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Gastrointestinal Agents (therapeutic use)
  • Humans
  • Male
  • Medical Records
  • Middle Aged
  • Minnesota (epidemiology)
  • Odds Ratio
  • Prednisone (therapeutic use)
  • Proportional Hazards Models
  • Retrospective Studies
  • Secondary Prevention
  • Time Factors
  • Treatment Outcome

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