INFLUENCE OF TOPICALLY AND SYSTEMICALLY ACTIVE STEROIDS ON CIRCULATING LEUKOCYTES IN CROHNS-DISEASE

Objective: Budesonide, although only topically active, is effective in the treatment of Crohn's disease. This study was performed to compare the clinical efficacies of budesonide and prednisolone in relation to the activation status of circulating leukocytes. Methods: Twenty-four patients with active Crohn's disease were randomized to treatment wit h either budesonide or 6-methylprednisolone. Clinical response was mon itored by the Crohn's disease activity index, C-reactive protein, and orosomucoid. Expression of CD25 and CD71 on T cells and CD64 on neutro phils was determined by flow cytometry. The release of TNF-alpha and I L-1 beta by peripheral blood mononuclear cells was measured by ELISA. Results: After 2 wk of treatment a clinical response was observed in b oth groups, but it was more accentuated in patients treated with predn isolone. At baseline an upregulation of CD71 and CD64, but not CD25, w as found in active patients. Prednisolone significantly decreased the expression of CD64 and the release of TNF-alpha and IL-1 beta, but did not alter the expression of CD25 and CD71. Budesonide treatment faile d to exert any effect on circulating leukocytes. Conclusions: The inab ility of budesonide to downregulate activated circulating leukocytes m ay contribute to the somewhat lower clinical efficacy of this topical steroid in the treatment of active Crohn's disease. (Am J Gastroentero l 1998;93: 1848-1853. (C) 1998 by Am. Coll. of Gastroenterology)