New article on benefits of Budesonide (Entocort) for MC

Zizzle · Post by **Zizzle** » Fri Jan 25, 2013 8:56 am

I'm pasting the article here because it required membership on Medscape:

Reuters Health Information
Corticosteroids Effective in Microscopic Colitis
Jan 17, 2013

NEW YORK (Reuters Health) Jan 17 - Corticosteroids improve outcomes in patients with microscopic colitis, according to findings from the Rochester (Minnesota) Epidemiology Project.

"Steroids (particularly budesonide) work very well in microscopic colitis, but the relapse rate is high and maintenance therapy is often needed," Dr. Darrell S. Pardi from the Mayo Clinic College of Medicine in Rochester, Minnesota, told Reuters Health.

In a 2007 report in Gut, a different team from the same region of Minnesota estimated the annual incidence of microscopic colitis per 100,000 population to be 19.6 cases, and its prevalence to be 103 cases.

Dr. Pardi and colleagues investigated the clinical characteristics and outcomes of 80 patients with collagenous colitis and lymphocytic colitis who were treated with corticosteroids. These patients represented about a quarter of the 315 individuals diagnosed with microscopic colitis between 1986 and 2010.

The percentage of patients treated with corticosteroids during this period increased from 0% between 1986 and 1995 to 62.5% between 2006 and 2010. Seventeen of the 80 patients (21.3%) were treated with prednisone, and 63 (78.7%) received budesonide.

The median daily starting doses were 9 mg for budesonide and 25 mg for

prednisone was 25 mg. Before starting either drug, patients had failed loperamide, bismuth subsalicylate, mesalamine, diphenoxylate / atropine,

psyllium, and cholestyramine.

Six patients were lost to follow-up. Of the remaining 74 patients, 56 (75.7%) had a complete response and 15 (20.3%) had a partial response.

Complete response rates were significantly higher with budesonide than with prednisone (82.5% vs 52.9%; p=0.02).

Responses to therapy were similar in the patients with collagenous colitis and lymphocytic colitis, the authors reported online January 8 in the American Journal of Gastroenterology.

During a median four years of follow-up in 73 patients, the likelihood of recurrence was 62% lower with budesonide than with prednisone, and the median time to recurrence was significantly shorter after stopping prednisone than after stopping budesonide (21.0 vs 63.5 days).

Among the 71 responders, 50 (70.4%) had recurrence after steroid discontinuation. Forty-seven of 73 patients (64.4%) with follow-up information required maintenance with corticosteroids.

"I favor budesonide over prednisone mostly due to fewer side effects, as well as much more robust data in favor of budesonide in the form of several clinical trials," Dr. Pardi concluded. "Our study is supportive, but since it was not a randomized study, and since some of the patients who were treated with prednisone got relatively low doses, I think the comparisons need to be interpreted with caution."

"Together with other investigators, I am considering studies using aminosalicylates as well as the MMX formulation of budesonide for maintenance treatment in microscopic colitis in the near future," Dr. Pardi added. "Long term, we need to look for steroid sparing drugs to treat these patients."

Dr. Stephan Miehlke from the Center for Digestive Diseases in Hamburg, Germany, told Reuters Health by email, "The key message is that budesonide should be that treatment of choice at least for short term treatment of microscopic colitis due to its high efficacy and good tolerability."

"The value of prednisolone is uncertain," Dr. Miehlke said. "There is only one randomized controlled trial which was negative. Moreover, budesonide is approved in many European countries for the treatment of collagenous colitis."

He added, "Future research is necessary to explore effective and safe long-term treatment strategies for microscopic colitis (we are working on that)."

SOURCE: http://bit.ly/13J2JPg

Am J Gastroenterol 2013.

Kaysbag · Post by **Kaysbag** » Wed Mar 13, 2013 9:20 pm

Thanks Zizzle, for posting this article. I'm new this week. My Gastroenterologist has mentioned budesonide as the next step if Lomotil and Imodium don't work, (haven't worked for 5+months). I've decided to do elimination diet first but it's nice to know that this drug is of some help, if needed.
thanks,
Kay

Polly · Post by **Polly** » Thu Mar 14, 2013 6:48 am

Hi Z.,

Glad to see the word is getting out, especially that maintenance therapy may be needed. That is our experience here. I would love to see the relapse rates for those who also adopt dietary changes vs. those who don't. But, of course, the food sensitivity part of MC is still in the dark ages. This site still has the cutting edge info about how to control MC and get your life back!!

Love,

Polly

coryhub · Post by **coryhub** » Thu Mar 14, 2013 1:10 pm

Hi Z,

Thanks for sharing the article.
We could have told them what the results would be and saved them the money. Wonder what the Dr. means by "Maintenance therapy"?

Dr. Pardi added. "Long term, we need to look for steroid sparing drugs to treat these patients."

No kidding bro!

Gloria · Post by **Gloria** » Thu Mar 14, 2013 10:17 pm

the median time to recurrence was significantly shorter after stopping prednisone than after stopping budesonide (21.0 vs 63.5 days).

This number (63.5 days) is remarkably close to the 56 days that we have found as the finish line for being in remission. Perhaps we should extend the expected time to be 9 weeks, not 8.

Gloria

ant · Post by **ant** » Fri Mar 15, 2013 1:57 am

Dear Gloria

Best wishes, ant

DebE13 · Post by **DebE13** » Fri Mar 15, 2013 4:59 am

Polly, didn't you know that diet has absolutely no bearings on this disease? You must be misinformed. Even my doctor said so. LMAO

Polly · Post by **Polly** » Fri Mar 15, 2013 7:03 am

HAHAHAHAHAHAHA, Deb!

Many thanks to you and your doc for setting me straight!

Love,

Polly