Microscopic Colitis: What to Do When Immunomodulators and Biologics Have Not Achieved Remission

Some patients with microscopic colitis do not achieve or sustain clinical remission despite a full course of medical therapy. When thiopurines, anti-TNF agents, and other advanced therapies have been tried without meeting treatment goals, a further management step may need to be considered.

Prior therapy — escalation trigger

The previous treatment step included agents such as thiopurines (azathioprine or 6-mercaptopurine), anti-TNF agents (adalimumab or infliximab), or vedolizumab — alongside symptomatic measures including loperamide and cholestyramine where appropriate.

The goal of that approach — induction and maintenance of clinical remission — was not achieved, warranting escalation to this protocol.

Next-line approach (partial overview)

For carefully selected patients in whom all medical therapy has been exhausted without success, a non-pharmacological intervention may be considered. Full eligibility criteria and the decision framework are available in the complete protocol.

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Primary clinical goal: Cessation of diarrhoea.

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References

DOI: 10.1177/2050640620951905

Surgery can be considered in selected patients as last option if all medical therapy fails.
Postoperatively, diarrhoea ceased in all patients; however, clinical symptoms recurred after restoration of intestinal continuity.

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