Despite high rates of response to an 8-week course of oral budesonide, the relapse rate after discontinuation is 60% to 80% with variable time to relapse.[63]Gentile NM, Abdalla AA, Khanna S, et al. Outcomes of patients with microscopic colitis treated with corticosteroids: a population-based study. Am J Gastroenterol. 2013 Feb;108(2):256-9.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3575108
http://www.ncbi.nlm.nih.gov/pubmed/23295275?tool=bestpractice.com
[78]Münch A, Bohr J, Miehlke S, et al. Low-dose budesonide for maintenance of clinical remission in collagenous colitis: a randomised, placebo-controlled, 12-month trial. Gut. 2016 Jan;65(1):47-56.
https://gut.bmj.com/content/65/1/47.long
http://www.ncbi.nlm.nih.gov/pubmed/25425655?tool=bestpractice.com
For patients who relapse after discontinuing oral budesonide, restarting budesonide at the lowest effective dose is recommended for maintenance of remission.[3]Nguyen GC, Smalley WE, Vege SS, et al. American Gastroenterological Association Institute guideline on the medical management of microscopic colitis. Gastroenterology. 2016 Jan;150(1):242-6.
https://www.gastrojournal.org/article/S0016-5085(15)01625-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/26584605?tool=bestpractice.com
See Management approach.
Many patients considered to be in remission report persisting symptoms such as abdominal pain, fatigue, arthralgia, or myalgia several years after diagnosis.[81]Nyhlin N, Wickbom A, Montgomery SM, et al. Long-term prognosis of clinical symptoms and health-related quality of life in microscopic colitis: a case-control study. Aliment Pharmacol Ther. 2014 May;39(9):963-72.
https://onlinelibrary.wiley.com/doi/10.1111/apt.12685
http://www.ncbi.nlm.nih.gov/pubmed/24612051?tool=bestpractice.com