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Münch, Andreas
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Publications (10 of 23) Show all publications
Riviere, P., Münch, A., Michetti, P., Chande, N., de Hertogh, G., Schoeters, P., . . . Van Assche, G. (2019). Vedolizumab in Refractory Microscopic Colitis: An International Case Series. Journal of Crohn's & Colitis, 13(3), 337-340
Open this publication in new window or tab >>Vedolizumab in Refractory Microscopic Colitis: An International Case Series
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2019 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 13, no 3, p. 337-340Article in journal (Refereed) Published
Abstract [en]

Background Evidence for second-line therapy in patients with microscopic colitis [MC] failing budesonide is scarce, although anti-tumour necrosis factors [anti-TNFs], methotrexate and azathioprine have been reported to be effective in small cohort studies. Vedolizumab, a monoclonal antibody targeting 47-integrin, prevents homing of T-cells to the gut. We evaluated clinical remission with vedolizumab in budesonide-refractory MC patients. Methods We solicited gastroenterologists in Europe and Canada for cases of MC treated with vedolizumab. Vedolizumab 300 mg IV was administered at weeks 0, 2 and 6, and then every 8 weeks. Clinical remission and histological remission were defined as less than three stools per day and normalization of histology, respectively, after induction treatment. Results Eleven cases were retrieved (nine females, lymphocytic colitis [LC] n = 5, collagenous colitis [CC] n = 6). Median [interquartile range] disease duration at vedolizumab initiation was 51 [29-70] months. Nine of 11 patients had failed one immunosuppressant and ten of 11 at least one anti-TNF agent. After three infusions of vedolizumab, clinical remission was observed in 5/11 patients [two LC and three CC] of whom three remained well with maintenance therapy [median duration of 13 months]. Biopsies were obtained from 9/11 patients. Histological remission was observed in 3/4 patients with clinical remission [2/3 CC, 1/1 LC] and 0/5 patients without clinical improvement. Conclusion In a series of highly refractory MC patients, vedolizumab induced clinical remission in 5/11 subjects, of whom 75% showed normalized histology. Larger randomized trials are needed to assess the efficacy of vedolizumab in patients with MC.

Place, publisher, year, edition, pages
Oxford University Press, 2019
Keywords
microscopic colitis; refractory; vedolizumab; treatment outcome
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-157266 (URN)10.1093/ecco-jcc/jjy169 (DOI)000464942000010 ()30329034 (PubMedID)2-s2.0-85063950086 (Scopus ID)
Available from: 2019-06-12 Created: 2019-06-12 Last updated: 2019-06-17Bibliographically approved
Miehlke, S., Aust, D., Mihaly, E., Armerding, P., Boehm, G., Bonderup, O., . . . Münch, A. (2018). Efficacy and Safety of Budesonide, vs Mesalazine or Placebo, as Induction Therapy for Lymphocytic Colitis. Gastroenterology, 155(6), 1795-+
Open this publication in new window or tab >>Efficacy and Safety of Budesonide, vs Mesalazine or Placebo, as Induction Therapy for Lymphocytic Colitis
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2018 (English)In: Gastroenterology, ISSN 0016-5085, E-ISSN 1528-0012, Vol. 155, no 6, p. 1795-+Article in journal (Refereed) Published
Abstract [en]

BACKGROUND amp; AIMS: Lymphocytic colitis is a common cause of chronic, nonbloody diarrhea. However, the effects of treatment are unclear and randomized placebo-controlled trials were requested in a Cochrane review. We performed a randomized, placebo-controlled, multicenter study to evaluate budesonide and mesalazine as induction therapy for lymphocytic colitis. METHODS: Patients with active lymphocytic colitis were randomly assigned to groups given budesonide 9 mg once daily (Budenofalk granules), mesalazine 3 g once daily (Salofalk granules), or placebo for 8 weeks in a double-blind, double-dummy design. The primary endpoint was clinical remission, defined as amp;lt;= 21 stools (including amp;lt;= 6 watery stools), in the 7 days before week 8. RESULTS: The final analysis included 57 patients (19 per group). Most patients were female (72%) and the mean age was 59 years. The proportion of patients in clinical remission at week 8 was significantly higher in the budesonide group than in the placebo group (intention-to-treat analysis, 79% vs 42%; P=.01). The difference in proportions of patients in clinical remission at week 8 between the mesalazine (63%) and placebo groups was not significant (P=.09). The proportion of patients with histologic remission at week 8 was significantly higher in the budesonide group (68%) vs the mesalazine (26%; P=.02) or placebo (21%; P=.008) groups. The incidence of adverse events was 47.4% in the budesonide group, 68.4% in the mesalazine group, and 42.1% in the placebo group. CONCLUSIONS: In a randomized multicenter study, we found oral budesonide 9 mg once daily to be effective and safe for induction of clinical and histologic remission in patients with lymphocytic colitis, compared with placebo. Oral mesalazine 3 g once daily was not significantly better than placebo. ClinicalTrials.gov no: NCT01209208.

Place, publisher, year, edition, pages
W B SAUNDERS CO-ELSEVIER INC, 2018
Keywords
Corticosteroid; 5-Aminosalicylic Acid; Microscopic Colitis; Intraepithelial Lymphocytes
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-153520 (URN)10.1053/j.gastro.2018.08.042 (DOI)000451781000033 ()30195447 (PubMedID)
Note

Funding Agencies|Dr Falk Pharma GmbH, Freiburg, Germany; Dr Falk Pharma GmbH

Available from: 2019-01-02 Created: 2019-01-02 Last updated: 2019-05-01
Wickbom, A., Bohr, J., Nyhlin, N., Eriksson, A., Lapidus, A., Münch, A., . . . Tysk, C. (2018). Microscopic colitis in patients with ulcerative colitis or Crohns disease: a retrospective observational study and review of the literature. Scandinavian Journal of Gastroenterology, 53(4), 410-416
Open this publication in new window or tab >>Microscopic colitis in patients with ulcerative colitis or Crohns disease: a retrospective observational study and review of the literature
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2018 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 53, no 4, p. 410-416Article in journal (Refereed) Published
Abstract [en]

Objectives: Onset of microscopic colitis (MC) in patients with ulcerative colitis (UC) or Crohns disease (CD), or vice versa, has been reported occasionally but the subject is not well described. We therefore report a retrospective observational study of such patients and review the literature.Methods: Forty-six Swedish gastroenterology clinics were contacted about patients with diagnoses of both inflammatory bowel disease (IBD) and MC. Publications were searched on PubMed.Results: We identified 31 patients with onset of MC after a median (range) of 20 (2-52) years after diagnosis of IBD, or vice versa; 21 UC patients developed collagenous colitis (CC) (n=16) or lymphocytic colitis (LC) (n=5); nine CD patients developed CC (n=5) or LC (n=4); one CC patient developed CD. Of the 21 UC patients, 18 had extensive disease, whereas no consistent phenotype occurred in CD. Literature review revealed 27 comprehensive case reports of patients with diagnoses of both IBD and MC. Thirteen MC patients developed IBD, of which four required colectomy. Fourteen IBD patients later developed MC. There were incomplete clinical data in 115 additional reported patients.Conclusions: Altogether 173 patients with occurrence of both IBD and MC were found. The most common finding in our patients was onset of CC in a patient with UC. Although these are likely random associations of two different disorders, MC should be considered in the patient with UC or CD if there is onset of chronic watery diarrhoea without endoscopic relapse of IBD.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD, 2018
Keywords
Collagenous colitis; lymphocytic colitis; microscopic colitis; ulcerative colitis; Crohns disease; inflammatory bowel disease
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-147964 (URN)10.1080/00365521.2018.1430252 (DOI)000430726600005 ()29546806 (PubMedID)
Note

Funding Agencies|Orebro County Research Committee

Available from: 2018-05-23 Created: 2018-05-23 Last updated: 2018-11-22
Westerlind, H., Mellander, M.-R., Bresso, F., Munch, A., Bonfiglio, F., Assadi, G., . . . D'Amato, M. (2017). Dense genotyping of immune-related loci identifies HLA variants associated with increased risk of collagenous colitis.. Gut, 66(3), 421-428
Open this publication in new window or tab >>Dense genotyping of immune-related loci identifies HLA variants associated with increased risk of collagenous colitis.
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2017 (English)In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 66, no 3, p. 421-428Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Collagenous colitis (CC) is a major cause of chronic non-bloody diarrhoea, particularly in the elderly female population. The aetiology of CC is unknown, and still poor is the understanding of its pathogenesis. This possibly involves dysregulated inflammation and immune-mediated reactions in genetically predisposed individuals, but the contribution of genetic factors to CC is underinvestigated. We systematically tested immune-related genes known to impact the risk of several autoimmune diseases for their potential CC-predisposing role.

DESIGN: Three independent cohorts of histologically confirmed CC cases (N=314) and controls (N=4299) from Sweden and Germany were included in a 2-step association analysis. Immunochip and targeted single nucleotide polymorphism (SNP) genotype data were produced, respectively, for discovery and replication purposes. Classical human leucocyte antigen (HLA) variants at 2-digit and 4-digit resolution were obtained via imputation from single marker genotypes. SNPs and HLA variants passing quality control filters were tested for association with CC with logistic regression adjusting for age, sex and country of origin.

RESULTS: Forty-two markers gave rise to genome-wide significant association signals, all contained within the HLA region on chromosome 6 (best p=4.2×10(-10) for SNP rs4143332). Among the HLA variants, most pronounced risk effects were observed for 8.1 haplotype alleles including DQ2.5, which was targeted and confirmed in the replication data set (p=2.3×10(-11); OR=2.06; 95% CI (1.67 to 2.55) in the combined analysis).

CONCLUSIONS: HLA genotype associates with CC, thus implicating HLA-related immune mechanisms in its pathogenesis.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2017
Keywords
COLLAGENOUS COLITIS; GENETICS; HLA GENES
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-125456 (URN)10.1136/gutjnl-2015-309934 (DOI)000394495800007 ()26525574 (PubMedID)
Note

Funding agencies: Swedish Research Council [VR 2010-2976, VR 2013-3862]; Swedish Society of Medicine; Research Council of South-East Sweden (FORSS); County Council of Ostergotland (ALF); Bengt Ihres fond; Bengt Ihre Research Fellowship; Magtarmfonden; Stockholm County Coun

Available from: 2016-02-24 Created: 2016-02-24 Last updated: 2017-11-30
Münch, A. & Verhaegh, B. (2016). Cross-border scientific projects run by UEG national member societies reduce health inequalities across Europe. United European Gastroenterology journal, 4(3), 478-478
Open this publication in new window or tab >>Cross-border scientific projects run by UEG national member societies reduce health inequalities across Europe
2016 (English)In: United European Gastroenterology journal, ISSN 2050-6406, E-ISSN 2050-6414, Vol. 4, no 3, p. 478-478Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
SAGE PUBLICATIONS INC, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-129671 (URN)10.1177/2050640616651200 (DOI)000377207300021 ()
Available from: 2016-06-27 Created: 2016-06-23 Last updated: 2017-11-28
Münch, A., Bohr, J., Miehlke, S., Benoni, C., Olesen, M., Ost, A., . . . Ström, M. (2016). Low-dose budesonide for maintenance of clinical remission in collagenous colitis: a randomised, placebo-controlled, 12-month trial. Gut, 65(1), 47-56
Open this publication in new window or tab >>Low-dose budesonide for maintenance of clinical remission in collagenous colitis: a randomised, placebo-controlled, 12-month trial
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2016 (English)In: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 65, no 1, p. 47-56Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: This 1-year study aimed to assess low-dose budesonide therapy for maintenance of clinical remission in patients with collagenous colitis.

DESIGN: A prospective, randomised, placebo-controlled study beginning with an 8-week open-label induction phase in which patients with histologically confirmed active collagenous colitis received budesonide (Budenofalk, 9 mg/day initially, tapered to 4.5 mg/day), after which 92 patients in clinical remission were randomised to budesonide (mean dose 4.5 mg/day; Budenofalk 3 mg capsules, two or one capsule on alternate days) or placebo in a 12-month double-blind phase with 6 months treatment-free follow-up. Primary endpoint was clinical remission throughout the double-blind phase.

RESULTS: Clinical remission during open-label treatment was achieved by 84.5% (93/110 patients). The median time to remission was 10.5 days (95% CI (9.0 to 14.0 days)). The maintenance of clinical remission at 1 year was achieved by 61.4% (27/44 patients) in the budesonide group versus 16.7% (8/48 patients) receiving placebo (treatment difference 44.5% in favour of budesonide; 95% CI (26.9% to 62.7%), p<0.001). Health-related quality of life was maintained during the 12-month double-blind phase in budesonide-treated patients. During treatment-free follow-up, 82.1% (23/28 patients) formerly receiving budesonide relapsed after study drug discontinuation. Low-dose budesonide over 1 year resulted in few suspected adverse drug reactions (7/44 patients), all non-serious.

CONCLUSIONS: Budesonide at a mean dose of 4.5 mg/day maintained clinical remission for at least 1 year in the majority of patients with collagenous colitis and preserved health-related quality of life without safety concerns. Treatment extension with low-dose budesonide beyond 1 year may be beneficial given the high relapse rate after budesonide discontinuation.

TRIAL REGISTRATION NUMBERS: http://www.clinicaltrials.gov (NCT01278082) and http://www.clinicaltrialsregister.eu (EudraCT: 2007-001315-31).

Place, publisher, year, edition, pages
B M J Group, 2016
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-112705 (URN)10.1136/gutjnl-2014-308363 (DOI)000366400500010 ()25425655 (PubMedID)
Note

Funding agencies: Dr Falk Pharma GmbH, Freiburg, Germany

Available from: 2014-12-08 Created: 2014-12-08 Last updated: 2017-05-03
Münch, A., Tysk, C., Bohr, J., Madisch, A., Bonderup, O. K., Mohrbacher, R., . . . Miehlke, S. (2016). Smoking Status Influences Clinical Outcome in Collagenous Colitis.. Journal of Crohn's & Colitis, 10(4), 449-454
Open this publication in new window or tab >>Smoking Status Influences Clinical Outcome in Collagenous Colitis.
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2016 (English)In: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 10, no 4, p. 449-454Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The relationship between clinical and histological parameters in collagenous colitis (CC) is poorly understood. Smoking is a risk factor for CC, whereas its impact on clinical activity and outcome is not well known.

METHODS: In a post hoc analysis of pooled data from two randomized controlled trials we assessed the association between demographic data (gender, age, smoking habits, family history of inflammatory bowel disease), clinical variables (duration of symptoms, mean number of stools/watery stools per day, abdominal pain, clinical remission) and histological data (thickness of the collagen band, inflammation of the lamina propria, total numbers of intraepithelial lymphocytes, degeneration). Moreover, we analysed the predictive value of baseline parameters for clinical outcome in a logistic regression model.

RESULTS: Pooled data were available from 202 patients with active CC, of whom 36% were current smokers, 29% former smokers and 35% non-smokers. Smoking status was associated with decreased ability to achieve clinical remission (current smokers vs non-smokers: odds ratio [OR] 0.31, 95% confidence interval [CI] 0.10-0.98, p = 0.045; former smokers vs non-smokers: OR 0.19, 95% CI 0.05-0.73, p = 0.016). Current smokers had an increased mean number of watery stools at baseline compared with non-smokers (p = 0.051) and increased mean number of watery stools per se was associated with decreased likelihood of obtaining clinical remission (OR 0.63, 95% CI 0.47-0.86, p = 0.003). Patient characteristics and histology at baseline had no association with clinical parameters and no predictive value for clinical outcome.

CONCLUSION: Smoking worsens clinical symptoms in CC and is associated with an increased number of watery stools and decreased likelihood of achieving clinical remission. There is no significant association between histology and clinical data.

Place, publisher, year, edition, pages
Oxford University Press, 2016
Keywords
Collagenous colitis; histology; predictive factors; smoking
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-125950 (URN)10.1093/ecco-jcc/jjv235 (DOI)000374262300011 ()26721941 (PubMedID)
Note

Funding agencies: Dr Falk Pharma

Available from: 2016-03-09 Created: 2016-03-09 Last updated: 2017-11-30
Daferera, N., Kumar Kumawat, A., Hultgren-Hornquist, E., Ignatova, S., Ström, M. & Münch, A. (2015). Fecal stream diversion and mucosal cytokine levels in collagenous colitis: A case report. World Journal of Gastroenterology, 21(19), 6065-6071
Open this publication in new window or tab >>Fecal stream diversion and mucosal cytokine levels in collagenous colitis: A case report
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2015 (English)In: World Journal of Gastroenterology, ISSN 1007-9327, E-ISSN 2219-2840, Vol. 21, no 19, p. 6065-6071Article in journal (Refereed) Published
Abstract [en]

In this case report, we examined the levels of cytokines expressed before and during fecal stream diversion and after intestinal continuity was restored in a patient with collagenous colitis. We report the case of a 46-year-old woman with chronic, active collagenous colitis who either failed to achieve clinical remission or experienced adverse effects with the following drugs: loperamide, cholestyramine, budesonide, methotrexate and adalimumab. Due to the intractable nature of the disease and because the patient was having up to 15 watery bowel movements per day, she underwent a temporary ileostomy. Colonic biopsies were analyzed for mucosal cytokine protein levels before and during fecal stream diversion and after intestinal continuity was restored. Mucosal protein levels of interleukin (IL)-1 beta, IL-2, IL-6, IL-12, IL-17 A, IL-23, TNF, IFN-gamma, IL-4, IL-5, IL-10 and IL-13 were all higher during active disease and decreased to non-detectable or considerably lower levels during fecal stream diversion. One month after the restoration of bowel continuity, when the patient experienced a relapse of symptoms, IL-2, IL-23 and IL-21 levels were again increased. Our results indicate that fecal stream diversion in this patient suppressed the levels of all cytokines analyzed in colonic biopsies. With the recurrence of clinical symptoms and histological changes after bowel reconstruction, the levels of primarily proinflammatory cytokines increased. Our findings support the hypothesis that a luminal factor triggers the inflammation observed in collagenous colitis.

Place, publisher, year, edition, pages
Baishideng Publishing Group Co. Limited, 2015
Keywords
Microscopic colitis; Collagenous colitis; Luminex; Mucosal cytokines; Fecal stream diversion
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-119587 (URN)10.3748/wjg.v21.i19.6065 (DOI)000355115600036 ()26019474 (PubMedID)
Note

Funding Agencies|Abbott; dr Falk Pharma

Available from: 2015-06-23 Created: 2015-06-22 Last updated: 2018-11-28
Langner, C., Aust, D., Ensari, A., Villanacci, V., Becheanu, G., Miehlke, S., . . . Münch, A. (2015). Histology of Microscopic Colitis - Review with Practical Approach for Pathologists. Histopathology, 66(5), 613-626
Open this publication in new window or tab >>Histology of Microscopic Colitis - Review with Practical Approach for Pathologists
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2015 (English)In: Histopathology, ISSN 0309-0167, E-ISSN 1365-2559, Vol. 66, no 5, p. 613-626Article, review/survey (Refereed) Published
Abstract [en]

Microscopic colitis has emerged as a major cause of chronic watery non-bloody diarrhoea, particularly in elderly females. The term is used as an umbrella term to categorize a subgroup of colitides with distinct clinicopathologic phenotypes and no significant endoscopic abnormalities: Lymphocytic colitis is defined by an increased number of surface intraepithelial lymphocytes, collagenous colitis by a thickened collagen band underneath the surface epithelium. There is increased inflammation in the lamina propria, but only little or no crypt architectural distortion. Incomplete and variant forms showing less characteristic features have been reported under different names. Differential diagnosis mainly includes resolving infectious colitis and changes related to the intake of drugs such as non-steroidal anti-inflammatory drugs. Substantial clinical and histological overlap between lymphocytic and collagenous colitis has been described, raising the suspicion that the conditions are two histological manifestations of the same entity, possibly representing different manifestations during the disease course or different stages of disease development. In this review we provide a practical approach for pathologists with focus on diagnostic criteria and differential diagnosis, discuss recent insights into the pathogenesis of disease and the relation to classical chronic inflammatory bowel disease, i.e. Crohn's disease and ulcerative colitis.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
Microscopic colitis; collagenous colitis; differential diagnosis; histopathology; incomplete forms; inflammatory bowel disease; lymphocytic colitis; pathogenesis; variant forms
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-112701 (URN)10.1111/his.12592 (DOI)000351378200001 ()25381724 (PubMedID)
Available from: 2014-12-08 Created: 2014-12-08 Last updated: 2017-12-05
Sänger, A. & Langner, C. (2015). Letter: Diagnosing Microscopic Colitis: Is Flexible Sigmoidoscopy a Reliable Alternative to Colonoscopy? Reply in CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, vol 13, issue 3, pp 618-619 [Letter to the editor]. Clinical Gastroenterology and Hepatology, 13(3), 618-619
Open this publication in new window or tab >>Letter: Diagnosing Microscopic Colitis: Is Flexible Sigmoidoscopy a Reliable Alternative to Colonoscopy? Reply in CLINICAL GASTROENTEROLOGY AND HEPATOLOGY, vol 13, issue 3, pp 618-619
2015 (English)In: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 13, no 3, p. 618-619Article in journal, Letter (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
WB Saunders, 2015
National Category
Gastroenterology and Hepatology
Identifiers
urn:nbn:se:liu:diva-115812 (URN)10.1016/j.cgh.2014.12.009 (DOI)000349754000044 ()25499995 (PubMedID)
Available from: 2015-03-20 Created: 2015-03-20 Last updated: 2017-12-04
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