Biologicals and JAK inhibitors hold promise in microscopic colitis

Biologic agents and small molecules appeared to be effective options in patients with microscopic colitis (MC) who were mostly budesonide-refractory or budesonide-dependent. JAK inhibitors delivered the highest clinical remission rates, although the number of patients treated with this type of small molecule was small.

“Currently, oral budesonide is the only approved therapy for patients with MC,” said Dr Bram Verstockt (University Hospitals Leuven, Belgium) at the start of his presentation [1]. However, this agent has several limitations, such as a high relapse rate when tapering off of budesonide, treatment resistance, and side effects like osteopenia with long-term exposure. Dr Verstockt and colleagues performed a retrospective case series study to explore the value of biological agents and small molecules in patients with MC (n=98). The population consisted predominantly of women (86.7%) and had a median age at diagnosis of 49.1 years.

TNF inhibitors were used in 77% of the study group, mostly as a first-line advanced therapy option. “This is probably due to the easy access to these agents,” added Dr Verstockt. Vedolizumab was another commonly-used therapy, used in 28% of the included patients, either in first- or second-line. Other biologicals or JAK inhibitors were only administered in a small number of patients. Clinical response and clinical remission rates, and their definitions, are summarised in the Figure; percentages were notably high for JAK inhibitors.

Figure: Clinical response and remission rates at the end of induction therapy [1]



Clinical response: 50% reduction in stool frequency; Clinical remission: <3 stools/day or <1 watery stool/day.

“Although this was a retrospective study, the results imply that advanced therapies can significantly improve the quality-of-life of patients with MC,” concluded Dr Verstockt. “The high response rate, high clinical remission rate, and promising treatment persistence rate among patients treated with JAK inhibitors encourage us to further evaluate the role of these agents in patients with MC.”

1. Verstockt B, et al. Promising efficacy of biologicals and small molecules for microscopic colitis: results from a large real-life multicenter cohort. DOP79, 19^th Congress of ECCO, 21–24 February 2024, Stockholm, Sweden.

Copyright ©2024 Medicom Medical Publishers



Posted on 18 April 202418 April 2024