title: Outcomes of patients with microscopic colitis treated with corticosteroids: a population-based study.
abstract: OBJECTIVE
  To evaluate the outcomes of corticosteroid-treated microscopic colitis (MC) in a population-based cohort, and to compare these outcomes in patients treated with prednisone or budesonide.
  
  
  METHODS
  A historical cohort study of Olmsted County, Minnesota residents diagnosed with collagenous or lymphocytic colitis (LC) between 1986 and 2010 was performed using the Rochester Epidemiology Project.
  
  
  RESULTS
  Of 315 patients with MC, 80 (25.4%) were treated with corticosteroids. The median age at colitis diagnosis was 66.5 years (range: 16-95) and 78.7% were female. Forty patients (50%) had LC and 40 (50%) had collagenous colitis. Prednisone was used in 17 patients (21.2%) and budesonide in 63 (78.8%); 56 (75.6%) had complete response and 15 (20.3%) had partial response. Patients treated with budesonide had a higher rate of complete response than those treated with prednisone (82.5 vs. 52.9%; odds ratio, 4.18; 95% CI, 1.3-13.5). Six patients were lost to follow-up. The remaining 74 had a median follow-up of 4 years (range 0.2-14). Fifty patients out of the 71 who responded (70.4%) had a recurrence after corticosteroid discontinuation. Patients treated with budesonide were less likely to recur than those treated with prednisone (hazard ratio, 0.38; 95% CI, 0.18-0.85; P=0.02). After 397 person years of follow-up in the 73 patients with long-term data, 47 (64.4%) required maintenance with corticosteroids.
  
  
  CONCLUSIONS
  Patients with MC often respond to corticosteroid therapy, but with a high relapse rate. Budesonide had a higher response rate and a lower risk of recurrence than prednisone.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Gentile
authors.forename: Adil A
authors.initials: AA
authors.lastname: Abdalla
authors.forename: Sahil
authors.initials: S
authors.lastname: Khanna
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Smyrk
authors.forename: William J
authors.initials: WJ
authors.lastname: Tremaine
authors.forename: William A
authors.initials: WA
authors.lastname: Faubion
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Kammer
authors.forename: William J
authors.initials: WJ
authors.lastname: Sandborn
authors.forename: Edward V
authors.initials: EV
authors.lastname: Loftus
authors.forename: Darrell S
authors.initials: DS
authors.lastname: Pardi
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D046728:Colitis, Microscopic / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology / Q000517:prevention & control; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D016017:Odds Ratio; D011241:Prednisone / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D005765:Gastrointestinal Agents; D019819:Budesonide; D011241:Prednisone