Budesonide outdoes mesalamine in treatment of microscopic colitis

Treatment with budesonide shows better clinical remission rates and fewer adverse events (AEs) than mesalamine in patients with microscopic colitis (MC), reveals a study.

Randomized clinical trials (RCTs) comparing either budesonide or mesalamine with a control group were searched in the databases of PubMed, Scopus, Web of Science, and Cochrane Library. A meta-analysis was performed using the generic inverse variance method, as well as a subgroup analysis based on the intervention administered. Nineteen RCTs met the eligibility criteria.

Budesonide was significantly associated with increased clinical remission rates (relative risk [RR], 2.46, 95 percent confidence interval [CI], 2.27‒2.67) compared with mesalamine (RR, 2.24, 95 percent CI, 1.95‒2.57) after 6 weeks of follow-up. The test of subgroup difference, however, showed no significant difference (p=0.25).

After 8 weeks of follow-up, the budesonide group demonstrated significantly higher rates of clinical remission (RR, 2.29, 95 percent CI, 2.14‒2.45) than the mesalamine group (RR, 1.7, 95 percent CI, 1.41‒2.05; p=0.003).

Patients treated with budesonide also showed less stool weight than those treated with mesalamine (MD, ‒351.62 vs ‒104.3; p=0.14), but this did not reach significance. However, daily stool frequency was significantly less with budesonide relative to mesalamine (p<0.001).

Furthermore, the incidence of AEs was significantly lower with budesonide than with mesalamine (p=0.001), but other safety endpoints did not significantly differ between treatment groups.

“MC is an inflammatory bowel disease of autoimmune origin that causes chronic watery diarrhoea,” the authors said. “Medications, including budesonide, mesalamine, loperamide, cholestyramine, and bismuth subsalicylate, are first-line therapies.”

For refractory MC, the recommended therapies are azathioprine, 6-mercaptopurine, and methotrexate, according to the authors.