Anti-TNFα agents safe, effective in steroid-refractory microscopic colitis

Treatment with vedolizumab and antitumour necrosis factor-α agents provides clinical benefits, with an acceptable safety profile, in patients with steroid-refractory microscopic colitis (MC), suggests a study.

A team of investigators identified retrospective studies and case series involving patients with steroid-refractory MC who were treated with vedolizumab, adalimumab, or infliximab.

Pooled proportional meta-analyses were conducted to determine the rate of clinical remission at induction, clinical response, maintenance of remission, histologic remission, and overall medication-related adverse events. The investigators also carried out a statistical analysis in R using the metafor and meta packages.

Fourteen studies, consisting of 164 patients overall, met the inclusion criteria. In pooled analysis, the clinical remission rates were 63.5 percent (95 percent confidence interval [CI], 0.483‒0.776; I2, 43 percent; p=0.08) with vedolizumab, 57.8 percent (95 percent CI, 0.3895‒0.7571; I2, 0 percent; p=0.7541) with infliximab, and 39.3 percent (95 percent CI, 0.0814‒0.7492; I2, 66 percent; p=0.02) with adalimumab.

The maintenance remission rates were 65.9 percent (95 percent CI, 0.389‒0.898; I2, 67 percent; p=0.02), 45.3 percent (95 percent CI, 0.1479‒0.7749; I2, 0 percent; p=0.36), and 32.5 percent (95 percent CI, 0.000‒0.8508; I2, 53 percent; p=0.14) for vedolizumab, infliximab, and adalimumab, respectively.

In addition, biological-related adverse events leading to treatment discontinuation occurred in 12.2 percent, 32.0 percent, and 23.0 percent of patients treated with vedolizumab, infliximab, and adalimumab, respectively.

“Future randomized controlled trials are needed to compare vedolizumab with TNF-α inhibitors and examine treatment effect on patients’ quality of life,” the investigators said.