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Article Dans Une Revue Journal of Crohn's and Colitis Année : 2024

DOP79 Promising efficacy of biologicals and small molecules for microscopic colitis: results from a large real-life multicenter cohort

1 UZ Leuven - Universitair Ziekenhuis Leuven
2 KU Leuven - Catholic University of Leuven = Katholieke Universiteit Leuven
3 Department of Gastroenterology and Hepatology
4 Hospital Universitario Mutua de Terrassa
5 CIBERehd - Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas
6 GHEF - Grand Hôpital de l'Est Francilien
7 Centre des maladies digestives Lausanne
8 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
9 Unipd - Università degli Studi di Padova = University of Padua
10 Internistische Gemeinschaftspraxis
11 Hospital of Lithuanian University of Health Sciences Kauno Klinikos [Kaunas, Lithuania]
12 CUH - Cambridge University Hospitals - NHS
13 DMS - Department of Medical Sciences [Turin, Italy]
14 CHUS - Complejo Hospitalario Universitario de Santiago de Compostela [Saint-Jacques-de-Compostelle, Espagne]
15 Copenhagen University Hospital
16 Hôpital Haut-Lévêque [CHU Bordeaux]
17 Service d'Hépato Gastroenterologie [CHU Amiens-Picardie]
18 PERITOX - Périnatalité et Risques Toxiques - UMR INERIS_I 1 UPJV
19 UZ-Gent
20 Service d'Hépato-gastro-entérologie [APHP Kremlin-Bicêtre]
21 Skane University Hospital [Lund]
22 Chaim Sheba Medical Center
23 CHU-Liège - Centre Hospitalier Universitaire de Liège
24 UZA - Antwerp University Hospital [Edegem]
25 ULB - Hôpital Erasme [Bruxelles]
26 University Hospital “Queen Joanna”
27 Tel Aviv Sourasky Medical Center [Tel Aviv]
28 Noorderhart Mariaziekenhuis [Pelt, Belgique]
29 IKEM - Institute for Clinical and Experimental Medicine
30 CHU UCL Namur
31 Ersta sjukhus [Stockholm]
32 Karolinska Institutet [Stockholm]
33 CHLS - Centre Hospitalier Lyon Sud [CHU - HCL]
34 Inflammatory Bowel Disease Center
35 AZ Sint-Maarten [Mechelen, Belgique]
36 Linköping university hospital
37 Hepatology and Gastroenterology
38 PREDICT - Center for Molecular Prediction of Inflammatory Bowel Disease [Copenhague]
M. Truyens
  • Fonction : Auteur
J.-F. Rahier
  • Fonction : Auteur
S. Nancey

Résumé

Background Microscopic colitis (MC) is a chronic inflammatory condition of the colon, resulting in an impaired quality of life due to debilitating watery diarrhea. First-line therapy consists of budesonide, though a subset of patients is refractory or becomes budesonide- dependent. Evidence for the efficacy of biologicals or small molecules in MC is sparse and limited to small case series. Hence, we aimed to generate more real-life efficacy data. Methods This retrospective series was collected as part of the CONFER project by ECCO and supported by the European Microscopic Colitis Group (EMCG). Cases of MC patients treated with advanced therapies were included through a standardised collection form. Clinical response was defined as a 50% reduction in stool frequency (SF); clinical remission was defined according to the Hjortswang criteria as < 3 stools/day or < 1 watery stool/day. Results Ninety-nine patients were identified (Table 1), of whom all but one were previously treated with budesonide. Reasons for budesonide discontinuation included primary non-response (PNR, 16.3%), refractory disease (34.7%), budesonide dependency (38.8%), or adverse events (AE, 10.2%). In total, 165 treatment cycles with advanced therapy (47 IFX, 40 ADA, 47 VDZ, 10 UST, 14 JAK inhibitors, 7 other) were reported. First-line advanced therapies included mainly anti-TNF (76.8%) and VDZ (20.2%) (Figure 1A). Patients were exposed to anti-TNF therapy for a median of 1.4 [0.5-3.1] years, with a significant drop in SF after induction (p<0.001), resulting in 50.0% clinical remission (Figure 1B). However, 63.0% ultimately discontinued anti-TNF therapy, mainly due to PNR (37.9%), loss-of-response (LOR, 36.2%) or AE (20.7%). VDZ induced 46.8% clinical remission, reflected in a significant drop in SF (p<0.001). Though, a 59.6% discontinuation rate was observed after a median 0.6 [0.3-1.3] years, mainly due to PNR (63.0%) and LOR (22.2%). Similarly, for UST a 40.0% clinical remission rate was accompanied by 60.0% therapy withdrawal, primarily due to PNR (83.3%). In contrast, JAK inhibition resulted in 78.6% clinical remission, with a substantial drop in SF (p=0.002) and 21.4% discontinuation rate after a median exposure of 0.6 [0.3-1.6] years. Conclusion Almost all advanced therapies are used in budesonide refractory or dependent MC, with anti-TNF agents the most often used first-line options. However, anti-TNF discontinuation is frequent due to lack/loss of efficacy. VDZ and UST could be alternatives, but also have a substantial discontinuation rate. In this retrospective series, the small number (n=14) of JAK inhibitor treated patients had the highest remission rate, suggesting further research on the role of JAK inhibitors in MC.

Dates et versions

hal-04573666 , version 1 (13-05-2024)

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Citer

B. Verstockt, T. Taelman, S. Vavricka, Y. Zabana, M. Lenfant, et al.. DOP79 Promising efficacy of biologicals and small molecules for microscopic colitis: results from a large real-life multicenter cohort. Journal of Crohn's and Colitis, 2024, 18 (Supplement_1), pp.i219-i221 Meeting Abstract DOP79. ⟨10.1093/ecco-jcc/jjad212.0119⟩. ⟨hal-04573666⟩
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