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

Abstract

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.

Management of ulcerative colitis in Taiwan: consensus guideline of the Taiwan Society of Inflammatory Bowel Disease

“…While steroids are standard treatment for remission induction in UC, first-generation steroids, such as prednisone, are not advised for use as maintenance treatment due to adverse events associated with long-term use, including increased risk of serious infections, bone disease, the development of cushingoid features, and increased risk of mortality 91. In a study evaluating the efficacy of budesonide-MMX for the maintenance of remission, the probability of relapse in patients receiving budesonide-MMX 6 mg was 40.9% compared to 59.7% in those receiving placebo, though the rate of maintained remission at month 12 was not significantly different between groups 71.…”

Systematic review: second‐generation vs. conventional corticosteroids for induction of remission in ulcerative colitis

“…Although trials have been smaller with less robust outcome measures vs. other agents in the class, beclomethasone dipropionate is the only second‐generation corticosteroid, to date, to demonstrate clinical efficacy for UC similar to that of conventional oral corticosteroids . Of note, oral formulations of beclomethasone dipropionate are not currently available in the USA . Budesonide MMX is approved for the induction of remission for mild‐to‐moderate UC in multiple countries.…”

Abnormal differentiation of stem cells into enteroendocrine cells in rats with DSS-induced colitis

“…Inflammatory bowel disease (IBD) is a chronic disease that consists of ulcerative colitis (UC) and Crohn's disease (1–4). The clinical course of IBD varies markedly, from frequent relapses, to chronic active disease, to years of complete remission (5).…”