Microscopic Colitis: What to Do When Initial Induction Therapy Has Not Achieved Remission
This protocol addresses the patient with microscopic colitis who has completed an initial induction course but has not reached the remission threshold — entering a pattern of chronic active disease that requires a different management approach.
Previous treatment — failure condition
Initial therapy — induction with oral budesonide together with avoidance of relevant risk factors (with loperamide or cholestyramine as alternatives where appropriate) — did not achieve the target outcome: clinical remission by the Hjortswang criteria (mean of fewer than 3 stools per day and fewer than 1 watery stool per day over a one-week registration period) within 6 to 8 weeks. Non-achievement of this endpoint is the trigger for escalating to a maintenance-focused protocol.
Next-line approach — overview
For chronic active microscopic colitis, evidence supports a long-term oral maintenance strategy — the agent, dose optimisation approach, and any adjunctive options are detailed in the full structured protocol.
Treatment goal: Maintenance of clinical remission with a lower risk of clinical relapse, assessed by the Hjortswang criteria over six months.
References
DOI: 10.1177/2050640620951905
We recommend using oral budesonide to maintain remission in patients with CC.
We suggest using oral budesonide to maintain remission in patients with LC.
In case of chronic active disease, long-term treatment with oral budesonide with the lowest possible dose for as long as needed is advised.
Results from two randomised clinical trials showed that maintenance therapy with budesonide 6 mg daily over six months resulted in a lower risk of clinical relapse (RR 0.34, 95% CI: 0.19–0.6).