P2662 - The Use of Biologics in Patients with Refractory Microscopic Colitis: A Single Center Experience

Chansong Choi, MD, Manuel Bonfim Braga Neto, MD, Victor Chedid, MD, MS, Darrell Pardi, MD, MS
Mayo Clinic, Rochester, MN

Introduction: Microscopic colitis (MC) is a cause of chronic watery diarrhea with associated symptoms including abdominal pain and weight loss. However, relapse rate is common after budesonide discontinuation, reported to be as high as 80%. Biologics such as anti-TNF and anti-integrins have recently been used for treatment of refractory MC with conflicting data regarding efficacy. We aimed to describe a single center experience of biologic use for refractory MC in a tertiary referral center.

Methods: A bioinformatics search tool was used to identify patients with ICD diagnosis of microscopic colitis between Jan 2000 and 2021 with either infliximab, adalimumab, or vedolizumab in their medication administration record. Data on patient demographics, symptoms, prior MC therapies, biologic use and endoscopic information was obtained. Clinical remission was defined as improvement of bowel movements to less than 3 watery stools/day. Steroid-free remission was defined as discontinuation of enteric and systemic steroids after initiation of biologics.

Results: After chart review, 22 patients with microscopic colitis without concomitant diagnosis of Crohn’s disease or ulcerative colitis were included. Eleven patients (50.0%) were treated with an anti-tumor necrosis factor biologic (anti-TNFs) and 11 patients were treated with vedolizumab (50.0%) Baseline and clinical characteristics are detailed in Table 1. Thirteen patients (59%) had lymphocytic colitis, 7 had collagenous colitis (32%) and 2 patients (9%) had mixed lymphocytic and collagenous subtype. The median age of biologic initiation was 54 years (37-63.5) in anti-TNF group and 59.5 (50-70) in vedolizumab group. Median time (range) between MC diagnosis and biologic initiation was 6 (4 - 8) and 3 (2 - 4) years, respectively. Clinical remission was achieved in 36% of patients (4 (36%) on anti-TNF and 4 (36%) on vedolizumab (36%). Histologic data at follow up was only available in 5 patients, with 1 in anti-TNF and 2 patients in anti-integrin achieving histologic remission. None of the patients experienced major adverse effects that required discontinuation of the biologics.

Discussion: Patients with refractory MC may be successfully treated with biologics. and demonstrate good efficacy and safety. Larger studies with prospective design are warranted to confirm these findings.



Disclosures:


Chansong Choi, MD, Manuel Bonfim Braga Neto, MD, Victor Chedid, MD, MS, Darrell Pardi, MD, MS. P2662 - The Use of Biologics in Patients with Refractory Microscopic Colitis: A Single Center Experience, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.