B0094 - Efficacy and Safety of Biologic Medications in Refractory Microscopic Colitis

Rajsavi Anand, MD¹, Lauren Burdine, MD¹, Joseph D. Feuerstein, MD^2
1Beth Israel Deaconess Medical Center, Boston, MA; ²Beth Israel Deaconess Medical Center (BIDMC), Boston, MA

Introduction: The current treatment for microscopic colitis (MC) involves use of antidiarrheals, budesonide, and avoidance of exacerbating medications. However, there is currently no treatment guideline for use of biologic medications as advanced therapy in patients who continue to have severe symptoms despite first line treatment options. In this study, we analyzed the clinical use, safety profile, and efficacy of biologic medications in refractory microscopic colitis.

Methods: Patients at a large academic center in Boston, MA with an ICD-10 diagnosis of collagenous colitis or lymphocytic colitis were included in this study. These patients were further narrowed to include patients who had been on infliximab, adalimumab, vedolizumab, or ustekinamab. Each patient chart was individually reviewed by two authors (RA, LB), with conflicting charts reviewed by a gastroenterologist (JDF). Data regarding date of diagnosis, histologic phenotype, demographics, concomitant GI illness, medications prior to biologic use, biologics trialed, length of treatment, adverse events, and clinical outcomes were analyzed descriptively.

Results: 1947 patients were identified with a diagnosis of MC. 98 (5%) of those patients had been exposed to biologics, and only 12 (< 1%) total patients were started on a biologic medication primarily for MC (as opposed to other concomitant conditions). The average length of diagnosis prior to biologic was 1.7 +/- 1.6 years (Table 1). The average length of biologic treatment was 3.7 +/- 3.3 years with eight patients continuing medication currently. Four patients achieved clinical remission, and four switched biologic class or medication due to medication non-effectiveness. There were two adverse reactions: ustekinumab associated with an anaphylaxis type allergic reaction two years after initiating therapy and infliximab associated with a pelvic abscess 6.7 years after initiating therapy. At both six weeks and at six months, four of the nine patients (44.4%) with data were in clinical remission. On follow up colonoscopy, zero patients had histologic resolution of their microscopic colitis.

Discussion: In patients with MC, only a very small percentage were initiated on biologic therapy for directed therapy. Of these, there were patients who achieved clinical remission, suggesting a clinical benefit to some patients in this population. MC has a low incidence and few patients are prescribed biologics; therefore, more research is needed to establish guidelines for use of biologics in treatment.



Disclosures:


Rajsavi Anand, MD¹, Lauren Burdine, MD¹, Joseph D. Feuerstein, MD². B0094 - Efficacy and Safety of Biologic Medications in Refractory Microscopic Colitis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.