David
Co-Founder
The article, "Topically Active Steroid Preparations" by John K. Marshall is a part of the book, "Advanced Therapy in Inflammatory Bowel Disease" which I recommend to anyone interested in the deeper medical side of Crohn's Disease. This thread will contain what I gleam from the article and it is open for discussion as well. This article is supported by 62 references.
- Systemic corticosteroids like Prednisone are commonly used for Crohn's Disease and Ulcerative Colitis but their side effects suck. Therefore, other steroid formulations without so many side effects would be great.
- Tixocortol, pavalate, beclomethasone, and fluticasone are such formulations but the popular one is Budesonide (Entocort).
- Budesonide is a synthetic analog of prednisolone and mostly works because it activates the corticosteroid receptor.
- Budesonide is also shown to increase bile acid absorption which can reduce diarrhea.
- Avoid drinking grapefruit juice with Budesonide as it'll screw it up.
- Budesonide is available as time released oral form or liquid enemas.
- The most popular oral form of Budesonide dissolves above ph 5.5 so most of the drug is released in the ileum and cecum.
- The main indication for oral Budesonide is Crohn's Disease of the ileocecal region. This would include the terminal ileum, ileocecal valve, and cecum.
- One study found 15mg and 9mg of Budesonide was better than placebo for ileal, ileal colonic, and proximal colon disease. 3mg was not better.
- A study found that starting at 12mg then tapering for 4 weeks was better than just 9mg daily at the 7 week mark.
- Budesonide has been found to be superior to 5-ASA for remission.
- A Cochrane review of nine trials found that normal corticosteroids are more effective than Budesonide, especially in patients with more severe disease or colon involvement.
- Budesonide is ineffective for maintaining remission beyond 7-12 months whether medically induced or surgically induced.
- Azathioprine is better than Budesonide for mucosal healing in patients with steroid dependent ileocolonic disease. Azathioprine had rates of 83% healing and Budesonide only 20%.
- The author feels Budesonide is good for people with mild to moderate Crohn's Disease of the ileocecal region for inducing remission.
- In one trial, Budesonide enemas were better than placebo for people with Ulcerative Colitis in the distal region of the colon.
- Budesonide is a first line treatment for people with Microscopic Colitis and can maintain remission at 6mg daily.
- Budesonide showed less side effects than conventional corticosteroids but those effects can still happen.
- Budesonide doesn't appear to suppress the adrenal gland much, especially compared to conventional corticosteroids but kids may be more likely to have their adrenal gland suppressed than adults.
- The author feels Budesonide is relatively safe for children but feels more data is needed.
- Budesonide is a category C drug for pregnancy.
- Systemic corticosteroids like Prednisone are commonly used for Crohn's Disease and Ulcerative Colitis but their side effects suck. Therefore, other steroid formulations without so many side effects would be great.
- Tixocortol, pavalate, beclomethasone, and fluticasone are such formulations but the popular one is Budesonide (Entocort).
- Budesonide is a synthetic analog of prednisolone and mostly works because it activates the corticosteroid receptor.
- Budesonide is also shown to increase bile acid absorption which can reduce diarrhea.
- Avoid drinking grapefruit juice with Budesonide as it'll screw it up.
- Budesonide is available as time released oral form or liquid enemas.
- The most popular oral form of Budesonide dissolves above ph 5.5 so most of the drug is released in the ileum and cecum.
- The main indication for oral Budesonide is Crohn's Disease of the ileocecal region. This would include the terminal ileum, ileocecal valve, and cecum.
- One study found 15mg and 9mg of Budesonide was better than placebo for ileal, ileal colonic, and proximal colon disease. 3mg was not better.
- A study found that starting at 12mg then tapering for 4 weeks was better than just 9mg daily at the 7 week mark.
- Budesonide has been found to be superior to 5-ASA for remission.
- A Cochrane review of nine trials found that normal corticosteroids are more effective than Budesonide, especially in patients with more severe disease or colon involvement.
- Budesonide is ineffective for maintaining remission beyond 7-12 months whether medically induced or surgically induced.
- Azathioprine is better than Budesonide for mucosal healing in patients with steroid dependent ileocolonic disease. Azathioprine had rates of 83% healing and Budesonide only 20%.
- The author feels Budesonide is good for people with mild to moderate Crohn's Disease of the ileocecal region for inducing remission.
- In one trial, Budesonide enemas were better than placebo for people with Ulcerative Colitis in the distal region of the colon.
- Budesonide is a first line treatment for people with Microscopic Colitis and can maintain remission at 6mg daily.
- Budesonide showed less side effects than conventional corticosteroids but those effects can still happen.
- Budesonide doesn't appear to suppress the adrenal gland much, especially compared to conventional corticosteroids but kids may be more likely to have their adrenal gland suppressed than adults.
- The author feels Budesonide is relatively safe for children but feels more data is needed.
- Budesonide is a category C drug for pregnancy.
