Letter: the definition of budesonide dependence in microscopic colitis

Abstract

SIRS,We read with interest the excellent article of Cotter et al. on the immune modulator therapy for microscopic colitis. 1 We think that this paper provides important information for the treatment of patients with budesonide-refractoriness. However, the authors defined budesonide dependence as "recurrence of diarrhoea after discontinuation of budesonide," a definition that we think is probably too broad. In fact, it is well known that budesonide is highly effective in inducing clinical remission in collagenous colitis, but the clinical relapse rate after budesonide discontinuation is very high (around 80%). [2][3][4] In view of the high relapse rate after withdrawal, it has been proposed to use low doses of budesonide to maintain remission. 4 This strategy has shown to be highly effective, maintaining clinical remission in 65%-80% of patients, with budesonide doses ranging from 4.5 to 6 mg/d for 6-12 months. Thus, in the absence of an international consensus to define "budesonide dependence" in microscopic colitis, we think that this definition should be restricted to those patients in whom clinical remission cannot be maintained using low-dose budesonide.

Letter: the definition of budesonide dependence in microscopic colitis—authors’ reply

“…Fernandez-Banares and Gisbert on our article. 1,2 We agree that our definition of budesonide dependence was broad, namely recurrence of diarrhoea after budesonide discontinuation. We also agree with their clinically important recommendation that maintenance budesonide should be used at the lowest effective dose, to minimise the risk of steroid-related side effects and cost, as noted in reviews from the USA and Europe.…”