A Cochrane review included 10 studies with a total of 277 subjects with active collagenous colitis. The pooled odds ratio for clinical response to treatment with oral budesonide was 12.32 (95% CI 5.53 to 27.46; 3 trials, n=94), with a number needed to treat (NNT) of 2 patients. There was significant histological improvement with treatment in all 3 trials. Budesonide also appears to improve patients' quality of life. In maintaining response, 80 patients who had responded to open-label budesonide were enrolled in 2 trials studying budesonide (6 mg daily for 6 months). Clinical response was maintained in 83% of patients who received budesonide compared to 28% of patients who received placebo (P = 0.0002). The pooled odds ratio for maintenance of clinical response to treatment with budesonide was 8.40 (95% CI 2.73 to 25.81, NNT 2). In a small (n=9) bismuth subsalicylate study (nine 262 mg tablets daily for 8 weeks) clinical response occurred in 100% of patients who received bismuth subsalicylate compared to 0% of patients who received placebo (P = 0.03). 23 patients were enrolled in the trial studying mesalamine (800 mg three times daily) with or without cholestyramine (4 g daily) for 6 months. Clinical response occurred in 73% of patients who received mesalamine alone compared to 100% of patients who received mesalamine + cholestyramine (P = 0.14). The effectiveness of prednisolone, Boswellia serrata extract, probiotics and other therapies is unknown.
A Cochrane review