Low bioavailability steroids in inflammatory bowel disease: an old chestnut or a whole new ballgame?

Abstract

At present, therapy of inflammatory bowel disease is still far from being fully satisfactory; old drugs like steroids, for instance, still represent a cornerstone in the treatment of active disease despite their associated important side effects and incomplete clinical efficacy. In the last years, new therapeutic strategies have been suggested in order to avoid or at least limit steroids use and in this direction the so-called low bioavailability steroids appeared to be a promising therapeutic weapon; however, some grey areas about their real utility and manner of use still remain. The aim of this review is to evaluate the available evidence about the use of oral budesonide and beclomethasone dipropionate in inflammatory bowel disease, to critically assess their current position in the therapeutic algorithm of these diseases and to give simple and practical indications for their use in every-day clinical practice.

Clinical Efficacy of Beclomethasone Dipropionate in Korean Patients with Ulcerative Colitis

“…In recent years, new therapeutic agents for IBD have been introduced with more favorable profiles in terms of safety and toxicity, compared to traditional steroids 5. Topically acting oral steroids are a group of drugs characterized by a low systemic bioavailability due to first-pass liver metabolism that minimizes the systemic concentration of the drug 6.…”

“…The European Crohn's and Colitis Organisation guidelines consider oral BUD as the first-choice drug for the treatment of mild-to-moderate Crohn's disease confined to the ileocecal area 7. Commercially available oral preparations of BUD have release systems that deliver BUD specifically to the distal ileum and proximal colon 5. Therefore, if BUD is taken orally, its efficacy fades out in the proximal colon.…”

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

“…fluticasone propionate, prednisolone metasulphobenzoate, beclomethasone dipropionate and budesonide) target delivery of steroids to the site of inflammation (i.e. distal small bowel and colon), thereby providing local (topical) anti‐inflammatory effects and potentially reducing systemic corticosteroid concentrations . With the exception of fluticasone propionate (a poorly absorbed, synthetic corticosteroid that undergoes extensive first‐pass metabolism), all of the second‐generation corticosteroids use novel drug technologies to ensure colonic targeting.…”

Different brain responses to electro-acupuncture and moxibustion treatment in patients with Crohn’s disease

“…Despite the high prevalence rate of Crohn’s disease, the treatment for CD is far from satisfactory45. Pharmacological treatment can induce the remission of CD symptoms, but the side effects of prolonged drug use limit its efficacy as a long-term treatment solution56.…”

“…Pharmacological treatment can induce the remission of CD symptoms, but the side effects of prolonged drug use limit its efficacy as a long-term treatment solution56. As an important part of Traditional Chinese Medicine, acupuncture and moxibustion are used in China and many other countries of the world.…”