BUDESONIDE FOR THE TREATMENT OF INFLAMMATORY BOWEL-DISEASE

While corticosteroids are the most effective treatment for the symptom atic management of patients with inflammatory bowel disease (IBD), the y cause serious side effects. Budesonide is a nonhalogenated glucocort icosteroid structurally related to 16 alpha-hydroxy-prednisolone that possesses high topical anti-inflammatory activity and low systemic act ivity compared with the conventional steroids prednisone and prednisol one. This favourable activity ratio is achieved because a high affinit y to the steroid receptor is coupled with rapid hepatic conversion to metabolites with minimal or no biological activity. Controlled trials in patients with distal ulcerative colitis indicate that budesonide en emas have equivalent or superior efficacy compared with 5-aminosalicyl ic acid (5-ASA) enemas, prednisolone disodium phosphate enemas or meth ylprednisolone enemas, without causing significant depression of endog enous cortisol levels. Two controlled trials investigating the efficac y of an oral controlled-ileal release for of budesonide for active Cro hn's disease have recently been completed. In the first trial, after e ight weeks' treatment budesonide 9 mg daily caused clinical remission in 51% of patients, compared with 20% of patients receiving placebo. B udesonide caused a dose-related reduction of plasma cortisol responses to adrenocorticotropic hormone stimulation, but was not associated wi th clinically important corticosteroid-related symptoms or other toxic ity. In a second trial, budesonide 9 mg daily was as effective as pred nisolone for induction of remission in active ileocecal Crohn's diseas e. Budesonide is a potentially promising new therapeutic agent for the management of patients with IBD.