Bone mineral density in relation to efficacy and side effects of budesonide and prednisolone in Crohn’s disease

Schoon, Erik J.; Bollani, S.; Mills, Peter R.; Israeli, Eran; Felsenberg, Dieter; Ljunghall, Sverker; Persson, Tore; Haptén-White, Louise; Graffner, Hans; Porro, G. Bianchi; Vatn, Morten H.; Stockbrügger, Reinhold W.

doi:10.1016/s1542-3565(04)00662-7

Cited by 142 publications

(71 citation statements)

References 33 publications

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“…A few trials have been conducted to investigate the bonerelated adverse events associated with budesonide; however, the results of these are conflicting. Short-term therapy with controlled-ileal-release budesonide did not impair osteoblast activity compared with oral methylprednisolone [D'Haens et al 1998], and was associated with better preserved bone mass compared with prednisolone in corticosteroid-naïve patients [Schoon et al 2005]. However, it has been shown that maintenance treatment with oral budesonide may be associated with lumbar spine and femoral neck bone loss [Cino and Greenberg, 2002].…”

Section: Tolerabilitymentioning

confidence: 99%

Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity

Prantera

Marconi

2013

Therap Adv Gastroenterol

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Inflammatory bowel diseases (IBDs) are a group of inflammatory conditions characterized by chronic, uncontrolled inflammation of the gastrointestinal tract. Reported prevalence is high in the United States and northern Europe, while the incidence varies greatly across the rest of Europe. Glucocorticosteroids are the standard treatment for IBD, but due to adverse events their use can be limited. However, new formulations of glucocorticosteroids have been developed to reduce systemic activation. The aim of this review was to assess and summarize the efficacy and safety of new formulations of glucocorticosteroids. A MEDLINE search identified publications focused on new formulations of nonsystemic steroidbased drugs for IBD and benefits and limitations of each of the new glucocorticosteroid formulations were identified. Budesonide has good efficacy and is an established treatment for Crohn's disease; it has been shown to be beneficial for the induction of remission in these patients, although it is not recommended for the maintenance of induced remission. Glucocorticosteroids are not recommended for the maintenance of remission in patients with IBD. However, a recent study suggested that beclomethasone dipropionate may be effective for prolonged treatment in patients in the postacute phase of Crohn's disease who were treated with a short course of systemic steroids. The efficacy of fluticasone propionate and prednisolone metasulphobenzoate in IBD is not well established given the small number of patients enrolled in the few published clinical trials. While the tolerability of these glucocorticosteroids is favourable, more research comparing these new agents with traditional systemic glucocorticosteroids is warranted.

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Section: Tolerabilitymentioning

confidence: 99%

Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity

Prantera

Marconi

2013

Therap Adv Gastroenterol

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“…High-dose corticosteroids have not been evaluated as maintenance therapy (16,17) . Long-term prednisone therapy can reduce relapse rates if doses are adjusted to maintain clinical remission, but at the expense of decreased bone mineral density (203) and other steroid-related toxicities (204) . Budesonide, 6 mg / day, can allow withdrawal of systemic steroids for steroid-dependent patients with ileal and / or right colonic disease (205) and delay clinical relapse rates for 3 -6 months (206 -210) , but not at 1 year (211) .…”

Section: Maintenance Therapymentioning

confidence: 99%

Management of Crohn's Disease in Adults

2009

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Guidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifi cally valid research, derived from extensive review of published literature. When data that will withstand objective scrutiny are not available, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be fl exible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are infl exible and rarely violated. Given the wide range of choices in any health-care problem, the physician should select the course best suited to the individual patient and the clinical situation presented. These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. Expert opinion is solicited from the outset for the document. The quality of evidence upon which a specifi c recommendation is based is as follows: Grade A: Homogeneous evidence from multiple well-designed randomized (therapeutic) or cohort (descriptive) controlled trials, each involving a number of participants to be of suffi cient statistical power. Grade B: Evidence from at least one large well-designed clinical trial with or without randomization, from cohort or case -control analytic studies, or well-designed meta-analysis. Grade C: Evidence based on clinical experience, descriptive studies, or reports of expert committees. The Committee reviews guidelines in depth, with participation from experienced clinicians and others in related fi elds. The fi nal recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientifi c developments at a later time.

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“…In summary, budesonide is not significantly more effective than placebo (34, 54, 70-73, 75-77) or systemic corticosteroids (78) in maintaining clinical remission in CD.…”

Section: Budesonide Is Not the Drug Of Choice For Maintenance Of Remimentioning

confidence: 80%

Steroid Use in Crohn’s Disease

Vavricka

Schoepfer

Scharl

et al. 2014

Drugs

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The incidence and prevalence of Crohn's disease are increasing, particularly in the Western world and Asia. Corticosteroids have been used for decades to treat active Crohn's disease and remain the mainstay in the management of moderate-to-severe relapses in Crohn's disease. The use of corticosteroids, despite their efficacy, may be associated with several drawbacks. This review article provides a comprehensive account of the role of corticosteroids in inducing remission in adult patients with Crohn's disease, including aspects such as approaches to corticosteroid sparing and to minimize the risk of corticosteroid dependency, as well as the role of newer corticosteroids such as budesonide in reducing systemic adverse effects.

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Bone mineral density in relation to efficacy and side effects of budesonide and prednisolone in Crohn’s disease

Cited by 142 publications

References 33 publications

Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity

Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity

Management of Crohn's Disease in Adults

Steroid Use in Crohn’s Disease

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