Microscopic colitis: A review of etiology, treatment and refractory disease

Table 1 Factors associated with microscopic colitis

Autoimmune disorder (type 1 diabetes, rheumatoid arthritis, celiac disease, thyroid disorders)

Nonsteroidal anti-inflammatory drugs

Proton pump inhibitors

Serotoin reuptake inhibitors

Statins

Beta-blockers

Smoking

Table 2 Summary of studies demonstrating efficacy of budesonide for treating microscopic colitis

	Number of patients	Mean age (yr)	Treatment	Remission rate1	Relapse rate2
Miehlke et al[31], 2008	48	57.5	Budesonide 9 mg/d for 6 wk, followed by budesonide 6 mg/d vs placebo for 6 mo	Short-term 96%	26% vs 65% placebo, P = 0.022
				Long-term 74% vs 35% placebo, P = 0.008
Bonderup et al[19], 2009	34	62.8	Budesonide 9 mg/d for 6 wk, followed by budesonide 6 mg/d vs placebo for 24 wk	Long-term	53%
				76.5% vs 12% placebo, P < 0.001
Miehlke et al[15], 2014	92	58.8	Budesonide 9 mg/d vs placebo for 8 wk	At 8 wk,	35%
				80% vs 59.5% placebo, P = 0.072
Münch et al[16], 2014	92	56.7	Budesonide 9 mg/d for 8 wk, followed by budesonide 4.5 mg/d vs placebo for 6 mo	Short-term 84.5%	82.1% vs 12.5% placebo
				Long-term
				61.4% vs 16.7% placebo, P < 0.001

¹Short-term remission rate is within 6 wk during induction phase. Long-term remission rate is at 6 mo of maintenance therapy, unless otherwise specified;

²After discontinuation of therapy.

Table 3 Response rate to immunomodulators and anti-tumor necrosis factor for severe or refractory microscopic colitis

	Number of patients	Mean age (yr)	Treatment	Duration of therapy	Response rate
Münch et al[22], 2013	46	59	Azathioprine or 6-MP 2 mg/kg per day	Variable, 1-57 mo	41%
Pardi et al[30], 2001	9	62	Azathioprine or 6-MP 2 mg/kg per day	26 mo	56%
Münch et al[21], 2013	9	62	Methotrexate 15-25 mg/wk	12 wk	0%
Esteve et al[25], 2011	4	59	Infliximab 5 mg/kg at 0, 2, 6 wk then every 6-8 wk intravenously	Variable, 5-14 mo	75%
Münch et al[26], 2012	3	55	Adalimumab induction1 then 40 mg subcutaneously every 2 wk	6 wk	66%
Pola et al[24], 2013	1	58	Infliximab 5 mg/kg at 0, 2, 6 wk then every 8 wk intravenously	6 mo	100%

¹Adalimumab induction: 160 mg (week 0), 80 mg (week 2), and 40 mg (week 4).