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P478 How often high-dose budesonide is necessary for maintenance treatment of collagenous colitis? Efficacy of azathioprine to maintain budesonide-free clinical remission

F. Fernández-Bañares*1, M. Piqueras2, D. Guagnozzi3, V. Robles4, A. Ruiz-Cerulla5, M. J. Casanova6, J. P. Gisbert6, D. Busquets7, A. Lucendo8, Y. Arguedas9, L. Fernández10

1Hospital Universitari Mutua Terrassa, Gastroenterology, CIBERehd, Terrassa, Spain, 2Consorci Sanitari Terrassa, Gastroenterology, Terrassa, Spain, 3Hospital Vall d’Hebron, Gastroenterology, Barcelona, Spain, 4Hospital Vall d’Hebron, Department of Gastroenterology, Barcelona, Spain, 5Hospital de Bellvitge, Gastroenterology, L’Hospitalet de Llobregat, Spain, 6Hospital Universitario de La Princesa, Gastroenterology, CIBERehd, Madrid, Spain, 7Hospital Universitari Dr Josep Trueta, Department of Gastroenterology, Girona, Spain, 8Hospital General De Tomelloso, Department of Gastroenterology, Tomelloso, Spain, 9Hospital San Jorge, Gastroenterology, Huesca, Spain, 10Hospital University Clinic Valladolid, Department of Gastroenterology, Valladolid, Spain

Background

Controlled studies show high efficacy of budesonide (BUD) to induce clinical remission in collagenous colitis (CC), but relapses are common after its suspension. The aim of the study was to evaluate the need for high-dose BUD (≥ 6 mg/d) for maintaining clinical remission in CC, and the efficacy of azathioprine as budesonide-sparing drug.

Methods

A retrospective cohort of 68 patients with CC (62 ± 1.6 years; 87% women) treated with BUD between 2008 and 2015 was studied. Frequency of BUD (9 mg/d) refractoriness, safety, and the need of BUD ≥ 6 mg/d for maintaining clinical remission were evaluated. Efficacy of azathioprine (AZA) as budesonide-sparing drug was studied. Logistic regression analysis was performed to evaluate the risk factors associated with the need to BUD ≥ 6 mg/d for maintaining clinical remission.

Results

BUD induced clinical remission in 64/68 (94%; 95% CI, 86%–98%) patients with good tolerance. 55% of them had one clinical relapse, and 23% 2 or more relapses. Fourteen of 64 patients (22%; 95% CI, 13.5%–33%) needed BUD ≥ 6 mg/d to maintain remission. Diarrhoea duration (≤ 24 vs > 24 months) (OR, 5.6; 95% CI, 1.1–28) and intake of NSAIDs (OR, 6.55; 95% CI, 1.3–33) were associated with the need for BUD ≥ 6 mg/d. AZA (2.2 ± 0.2 mg/kg/d) was administered in 6 patients (1 refractory to BUD and 5 with BUD≥6 mg/d) with response in 4 (67%), achieving the withdrawal (3) or a dose decrease (1) of BUD. AZA was stopped in 1 patient because of gastrointestinal intolerance, and mercaptopurine was started with good response. In 1 of the 2 patients with non-response, AZA was stopped because of myelotoxicity.

Conclusion

BUD is highly effective in inducing clinical remission in patients with CC. However, 20% of them require high doses of budesonide to maintain remission. Thiopurine drugs may be effective in maintaining budesonide-free clinical remission.