Corticosteroids are widely prescribed worldwide. It is estimated that, at any point of time, about 1% of the general population is receiving oral corticosteroids.
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Efficacy and tolerance of budesonide for the treatment of Crohn disease
Corticosteroids are commonly used for the induction of remission in Crohn’s disease. However, traditional corticosteroids can cause significant adverse events. Budesonide is an alternative glucocorticoid with limited systemic bioavailability.
One of the aims of this study was to evaluate the efficacy and safety of oral budesonide for the induction of remission in Crohn’s disease by comparison to conventional corticosteroids. This was achieved by reviewing all controlled trials comparing budesonide to conventional corticosteroids and by pooling the results of these studies.
MAIN RESULTS: Nine (779 patients) studies comparing budesonide to conventional corticosteroids were found. It was found that after eight weeks of treatment, budesonide was significantly less effective than
conventional steroids for induction of remission (52% of budesonide patients achieved remission at week 8 compared to 61% of patients who received conventional steroids), in particular among patients with
severe disease or more extensive colonic involvement. Fewer adverse events occurred in those treated with budesonide compared to conventional steroids (RR 0.64, 95% CI 0.54 to 0.76) and budesonide was better than conventional steroids in preserving adrenal function (RR for abnormal ACTH test 0.65, 95% CI 0.55 to 0.78).
In conclusion, although short-term efficacy with budesonide is less than with conventional steroids, particularly in those with severe disease or more extensive colonic involvement, the likelihood of adverse events and adrenal suppression with budesonide is lower.