THERAPEUTIC OPTIONS FOR PATIENTS WITH INFLAMMATORY BOWEL-DISEASE - NEW STEROIDS

Glucocorticoids are the mainstay of the medical management of inflamma tory bower disease (IBD) (Crohn's disease and ulcerative colitis). The pronounced immunosuppressive capacity of these drugs is closely relat ed to downregulation of gene expression of proinflammatory and immunor egulatory cytokines which are produced in increased amounts in active IBD. The well-known side effects of glucocorticoid treatment have prom pted the development of a new class of glucocorticoids with high topic al selectivity for bowel mucosa partly due to high first-pass hepatic metabolism. Budesonide is the only new steroid which has been extensiv ely developed for the treatment of inflammatory bower disease. Budeson ide enemas are as effective as conventional glucocorticoids in the tre atment of patients with distal ulcerative colitis, but with less adren al gland suppression. Budesonide controlled ileal release (CIR) capsul es, which deliver the active drug at the ileocecal region, are superio r to placebo and only slightly less effective than oral prednisolone i n the treatment of active Crohn's, but have less glucocorticoid-associ ated side effects. A similar sustained release formulation for oral tr eatment of extensive ulcerative colitis is in the development phase. T hese formulations of budesonide with topical selectivity for inflamed disease sites seem to represent a real step forward in the management of selected subgroups of patients with inflammatory bowel disease.