Visit the Microscopic Colitis Foundation Website
), explains why Entocort is not used more frequently. Wonder why it works so well in MC and not at all in UC? Do we have "right-sided" colitis? Back before the diet, I certainly felt most of the pain and bloating in the right side. This may help some of you seeking prescriptions for it, since it is being recognized lately for use in Crohn's.http://www.medscape.com/viewarticle/744686_3
Because of the high risk of undesirable side effects associated with systemic corticosteroids, there have been trials with oral budesonide, a corticosteroid with high topical activity and a much lower profile of adverse events. A recently published Cochrane meta-analysis of randomized controlled trials of oral budesonide in inducing clinical remission of ulcerative colitis determined that treatment with this agent had significantly lower efficacy than oral mesalamine (RR = 0.72, 95% CI 0.57–0.91) given for 8 weeks and was equally effective to placebo (RR = 1.41, 95% CI 0.59–3.39) given for 4 weeks.[39] Although one small study observed comparable efficacy of oral budesonide to prednisolone in inducing endoscopic remission (RR = 0.75, 95% CI 0.23–2.42), the small size and lack of power precluded assessment of clinical remission.[39,40] In light of currently available evidence, therapy with oral budesonide is not recommended in the treatment of active ulcerative colitis.
On the contrary, budesonide is recommended for the treatment of mild to moderately active ileocecal Crohn's disease as one of the first-line treatment options.[41,42] The most recent randomized, double-blind, double-dummy 8-week multicenter trial comparing budesonide (9 or 3 mg 3 times daily) with mesalamine (4.5 gm) for the treatment of mild-to-moderate active Crohn's disease confirmed that budesonide was numerically but not statistically more effective than mesalamine.[43] The Cochrane systemic review of randomized trials evaluating the efficacy of budesonide at a dose of 9 mg daily demonstrated budesonide to be more effective than placebo (RR 1.96, 95% CI 1.19–3.23) or mesalamine (RR 1.63; 95% CI 1.23–2.16) in inducing remission of mild-to-moderate active ileocecal Crohn's disease after 8 weeks of treatment.[44] Even though some clinical trials demonstrated comparable efficacy in inducing clinical remission between budesonide and prednisolone,[45] the recent Cochrane systematic review of nine randomized controlled trials demonstrated that budesonide at daily dose of 9 mg was inferior to conventional corticosteroids in inducing remission of Crohn's disease (RR 0.85, 95% CI 0.75–0.97).[44] On the contrary, the safety analysis of six trials revealed that budesonide was associated with significant reduction in adverse events related to corticosteroid use with a relative risk of 0.64 (95% CI 0.54–0.76).[44] Despite these results, budesonide has a limited target population for active Crohn's disease. It is not effective in approximately 20% of patients with active Crohn's disease (in particular, patients with extensive diseases who do not have ileocecal involvement or those with left-sided colitis).[46] There is also no supportive evidence for the efficacy of budesonide in fistulizing disease because all patients with fistulas were excluded from entering the trials, which evaluated the efficacy of budesonide. Therefore, in the light of the recent data, budesonide is not recommended as a maintenance treatment of Crohn's disease.
Maybe I'm just lazy. 