When patients with microscopic colitis achieve remission through induction therapy but experience a return of symptoms after that treatment is discontinued, a specific management strategy is indicated. This clinical relapse pattern — recurrence following cessation of induction therapy — requires a distinct, evidence-based approach.
The Clinical Setting
This protocol targets patients with microscopic colitis who develop a clinical relapse after stopping induction therapy. Evidence-based guidance specifically reserves maintenance therapy for this situation; it is not recommended as routine initial management for all patients.
Treatment Approach
Maintenance therapy with budesonide is the recommended approach in this setting — the specific dosing schedule, titration strategy, and planned duration are detailed in the full structured protocol.
Goals of Management
References
DOI: 10.1053/j.gastro.2015.11.008
For patients with recurrence of symptoms following discontinuation of induction therapy for microscopic colitis, the AGA recommends budesonide for maintenance of clinical remission.
The panel would like to emphasize that maintenance therapy should only be offered to patients with microscopic colitis who have had a clinical relapse after cessation of induction therapy.
Moderate-quality evidence from 2 randomized clinical trials showed that maintenance therapy with budesonide 6 mg daily over 6 months resulted in a 66% lower relative risk of clinical relapse (relative risk, 0.34; 95% confidence interval, 0.19–0.6).
This regimen also effectively maintained histological response and quality of life.
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