This protocol is for patients with chronic active microscopic colitis who have been on long-term oral budesonide maintenance but have not sustained clinical remission — or who require doses beyond the target maintenance range. It defines the evidence-based escalation step taken after that failure.
The preceding line used oral budesonide as long-term maintenance therapy for chronic active microscopic colitis. That line aimed to maintain clinical remission with a lower risk of relapse, assessed by the Hjortswang criteria over six months. This protocol applies when that goal was not achieved, or when sustaining remission required a dose exceeding the intended maintenance range.
Induction and maintenance of clinical remission of microscopic colitis.
For patients who are refractory to budesonide or who require unsustainably high doses, alternative medical therapy in the immunomodulator or biologic category is considered. The full protocol specifies which agents apply, the conditions governing their selection, and the complete management sequence.
DOI: 10.1177/2050640620951905
We recommend treatment with thiopurines, anti-tumor necrosis factor (TNF) drugs or vedolizumab in selected patients with MC who fail to respond to budesonide to induce and maintain clinical remission.
In budesonide-refractory patients and in patients requiring budesonide more than 6 mg per day to maintain clinical remission, alternative medical therapies including immunomodulators or biologics should be considered.
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