Visit the Microscopic Colitis Foundation Website
Darn the luck, however I found a backdoor into that site to stumble onto that article, the door is closed now...I did find a mention of higher doses used in this article...not as good as the first, but it talks about a 21 mg dose...
http://cme.medscape.com/viewarticle/460040_6
It's also going to want a log in, I'm afraid, so here is the article...
Mild to Moderate Crohn's Disease - Defining the Basis for a New
Previous Page
Next Page
In This Article
Summary and Introduction
Strategy for Identification of Controlled Clinical Trials
Sulfasalazine
Mesalamine
Systemic Corticosteroids
Budesonide
Antibiotics
Discussion
Recommendations: Defining the Basis for a New Treatment Algorithm
Figures
Tables
References
Budesonide
Once it was demonstrated that corticosteroids were effective in inducing remission of Crohn's disease, oral drug delivery systems were developed to provide the efficacy of a corticosteroid without the associated corticosteroid toxicity. Budesonide capsules (ENTOCORT EC), a product of this effort, have been evaluated for induction of remission of active mild to moderate Crohn's disease in several randomized, controlled, double-blind, multicentre trials (Table 6).[17,24-29]
Budesonide vs. Placebo
An 8-week study by Greenberg et al.[25] compared 3, 9 and 15 mg budesonide daily with placebo and showed that remission rates for patients treated with both the 9 and 15 mg dose of budesonide were significantly superior to placebo. Another 8-week trial failed to demonstrate that treatment with budesonide 9 mg once daily or 4.5 mg twice daily was significantly better than placebo.[28]
In a recently published meta-analysis of budesonide studies, Kane et al.[30] found that remission was induced significantly more frequently by budesonide than placebo, with an odds ratio of 1.85. Thus, a patient is significantly more likely to go into remission when treated with budesonide 9 mg daily than with placebo.
Budesonide vs. Mesalamine
As previously described, one trial has compared budesonide 9 mg daily with mesalamine 4 g daily in inducing remission of Crohn's disease and showed superior efficacy of budesonide compared with mesalamine at all time points evaluated.[17] In their meta-analysis, Kane et al. reported that budesonide was more likely to induce remission than mesalamine, with a calculated odds ratio of 1.73.[30] Accordingly, a patient is 73% more likely to achieve remission with budesonide than mesalamine.
Budesonide vs. Conventional Corticosteroids
Trials by Rutgeerts et al.[27] and Campieri et al.[24] showed that budesonide has similar efficacy to prednisolone with regard to inducing remission of Crohn's disease. Two other double-blind studies compared an oral pH-modified release (pH > 6.4) formulation of budesonide 9 mg/day (Budenofalk, which is not approved in the United States) with prednisone (40 mg tapered to 5 mg/day)[29] or 6-methylprednisolone (48 mg/day tapered to 8 mg/day).[26] No significant differences in remission rates were seen between the groups after 8 weeks of treatment in these two studies (Table 6). Although these three trials suggested that budesonide formulations have equivalent efficacy to conventional corticosteroid therapy, they were also not designed as formal non-inferiority studies. To further quantify the relative efficacy after the alternative treatment approaches Kane et al. performed a meta-analysis of these findings.[30] These authors concluded that conventional corticosteroids induced remission of mild to moderate Crohn's disease more frequently than budesonide (with an odds ratio of 0.87). In sub-group analysis, when patients had a lower CDAI (200-300) remission rates were not clinically different.
Tolerability of Budesonide
The side-effects frequently seen with conventional corticosteroid use are minimized in Crohn's disease patients treated with budesonide 9 mg/day due to its high first-pass metabolism and low systemic absorption (10-15%) (Table 7).
In their meta-analysis, Kane et al. found that budesonide capsules had a similar tolerability profile to placebo and mesalamine, and a greatly improved profile compared with prednisolone.[30] In an ongoing, uncontrolled, compassionate use study of more than 4000 Crohn's disease patients treated with doses of up to 21 mg budesonide per day, some for more than 5 years, serious adverse events were experienced by 3% of patients; most of these were gastrointestinal and unrelated to treatment.[31]
Previous Page
Section 6 of 9
Next Page: Antibiotics
Aliment Pharmacol Ther 18(3):263-277, 2003. © 2003 Blackwell Publishing
12 mg of Entocort a day?
Moderators: Rosie, Stanz, Jean, CAMary, moremuscle, JFR, Dee, xet, Peggy, Matthew, Gabes-Apg, grannyh, Gloria, Mars, starfire, Polly, Joefnh
I sure do. I think, (well, actually, I know), that what has happened in a lot of cases, is that many of the professional level medical reports, that were originally available for free, just a few years ago, have since been converted into "pay per view" documents, or "view by paid subscription only" documents, by over-priced "medical library" services.Carrie wrote:Don't you hate it when you stumble into a back door somewhere and don't copy the article while your there...
Hugs,
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Found it!!!!
Never underestimate the Web Witch 
Found a backdoor that opened for that original article...here it is...
Hugs,
Carrie
Medical treatments to induce remission in adults
Corticosteroids (oral) to induce remission
In this section:
Summary | Benefits | Harms | Comment
Top
Summary
One systematic review and two additional RCTs found that, compared with placebo, corticosteroids increased remission rates in active Crohn's disease, although remission rates for budesonide were slightly lower than for methylprednisolone and prednisolone. The optimal budesonide dose — and whether this should be given in a single or in two divided daily doses — remains unclear. One small RCT found similar remission rates between a 7-week and a 15-week tapering regimen of methylprednisolone. We found no evidence on the relative efficacy of methylprednisolone and prednisolone, or on different routes of administration. Two RCTs found that, compared with placebo, methylprednisolone and prednisolone increased adverse effects, including bleeding and infection. One systematic review found no significant difference in adverse effects between budesonide and placebo. The same review found that budesonide was associated with fewer adverse effects than methylprednisolone and prednisolone. One RCT found no significant difference in bone mineral density reduction between budesonide and prednisolone.
Top
Benefits
Methylprednisolone or prednisolone versus placebo:
We found no systematic reviews, but found two RCTs. [12] [13] The first RCT found that, compared with placebo, oral prednisolone 0.25–0.75 mg/kg daily (tapered over 17 weeks) significantly increased the proportion of people achieving clinical remission (defined as Crohn's Disease Activity Index [CDAI] score less than 150) at 17 weeks (1 RCT, 162 people, CDAI at least 150; Kaplan–Meier life table analysis: 24/40 [60%] with prednisolone v 17/57 [30%] with placebo; P less than 0.0001). [12] The second RCT found that, compared with placebo, oral methylprednisolone 48 mg daily (tapered over 6 weeks) significantly increased the proportion of people achieving clinical remission (defined as CDAI less than 150) at 18 weeks (1 RCT, 105 people aged at least 18 years, CDAI at least 150; AR 39/47 [83%] with methylprednisolone v 22/58 [38%] with placebo; P less than 0.05). [13]
Different methylprednisolone regimens:
We found no systematic reviews but found one RCT. [14] It found similar remission rates when methylprednisolone 40 mg daily for 3 weeks was tapered over 7 weeks compared with the same initial methylprednisolone dose tapered over 15 weeks. However, participant numbers were small (1 RCT, 54 people, CDAI 280–380; AR 22/27 [81%] after a 7-week course v 23/27 [85%] after a 15-week course; P value not reported).
Budesonide versus placebo:
We found one systematic review (search date 2005). [15] It found that, compared with placebo, budesonide 3–9 mg daily significantly increased the proportion of people who achieved remission at 8 weeks (2 RCTs, 324 people aged at least 18 years, with ileocolonic Crohn's disease not extending beyond the hepatic flexure; AR 109/218 [50%] with budesonide v 26/106 [25%] with placebo; OR 2.85, 95% CI 1.67 to 4.87). [15]
Different budesonide regimens versus each other:
We found one systematic review (search date 2002, 2 RCTs [16] [17] ) [18] and two additional RCTs. [19] [20] The first RCT identified by the review included four arms: 15 mg, 9 mg and 3 mg budesonide, and placebo, all given in two daily divided doses for 8 weeks. [16] It found that, compared with 3 mg budesonide and placebo, 9 mg and 15 mg budesonide significantly increased the proportion of people who achieved remission ( see table 1). The second RCT identified by the review found no significant difference in the proportion of people who achieved remission at 8 weeks between budesonide 9 mg daily in a single dose, budesonide 9 mg daily in two divided doses, and prednisolone 40 mg daily (reducing to 5 mg/day after 9 weeks) ( see table 1). [17] (Also see budesonide versus methylprednisolone or prednisolone below). The first additional RCT found no significant difference in the proportion of people who achieved remission at 8 weeks between budesonide 9 mg daily in a single dose, budesonide 9 mg daily in two divided doses, and placebo ( see table 1). [19] The second additional RCT compared 6 mg, 9 mg, and 18 mg budesonide (each in three daily divided doses). It found that, compared with 6 mg budesonide, the 9 mg and 18 mg dosages increased the proportion of people in remission at 6 weeks, although this reached significance only in the 18 mg group ( see table 1). [20]
Budesonide versus methylprednisolone or prednisolone:
We identified one systematic review (search date 2005). [15] It found that significantly fewer people achieved remission at 8 weeks with several budesonide regimens (3, 9, or 15 mg/day) than with prednisolone (40 mg daily tapering to 5 mg daily or 1 mg/kg tapering to 0.25 mg/kg daily) or with methylprednisolone (48 mg daily tapering to 8 mg daily; 5 RCTs, 667 people, CDAI greater than 150; AR 189/363 [52%] with budesonide v 186/304 [61%] with methylprednisolone and prednisolone; OR 0.69, 95% CI 0.51 to 0.95). (See also different budesonide regimens versus each other, above.)
Top
Harms
Methylprednisolone or prednisolone versus placebo:
We found two RCTs that gave information on adverse effects. [13] [21] The first RCT (119 people randomised to azathioprine, prednisolone, sulfasalazine, or placebo) found that prednisolone significantly increased petechial bleeding (6% v 0%; P less than 0.05), ecchymosis (17% v 3%; P less than 0.01), striae (6% v 0%; P less than 0.05), moon face (47% v 3%; P less than 0.01), acne (30% v 7%; P less than 0.01), hypertension (13% v 0%; P less than 0.01), and infection (27% v 10%; P less than 0.01) at 17 weeks compared with placebo. [21] It also found that prednisolone significantly reduced nausea and vomiting (38% v 19%; P less than 0.05) and anorexia (25% v 8%; P less than 0.01) at 17 weeks compared with placebo. The second RCT (452 people randomized to methylprednisolone, methylprednisolone plus sulfasalazine, sulfasalazine, or placebo for 6 weeks) found that methylprednisolone significantly increased the proportion of people with moon face at 2 years (2.51 per 100 participant months with methylprednisolone v 0.49 per 100 participant months with placebo; P less than 0.05) compared with placebo. [13]
Budesonide versus placebo or different budesonide regimens:
We found one systematic review (search date 2005). [15] It found no significant difference in adverse effects at 8 weeks between budesonide 3 mg, 9 mg, and 15 mg daily, and placebo (2 RCTs, 324 people; AR 115/220 [52%] with budesonide v 43/107 [40%] with placebo; OR 0.98, 95% CI 0.58 to1.67). [15]
Budesonide versus methylprednisolone or prednisolone:
We found one systematic review (search date 2005). [15] It found that budesonide significantly reduced the proportion of people with adverse effects compared with methylprednisolone or prednisolone (5 RCTs, 667 people; AR 136/364 [37%] with budesonide v 179/306 [58%] with conventional corticosteroids; OR 0.39, 95% CI 0.28 to 0.54). Budesonide also significantly reduced the proportion of people whose plasma cortisol levels were below the normal range (379 people; AR 81/229 [35%] with budesonide v 108/170 [64%] with conventional corticosteroids; OR 0.28, 95% CI 0.18 to 0.53). There was no significant difference between groups in the number of people who withdrew from the studies because of adverse effects (5 RCTs, 667 people; AR 37/362 [10%] with budesonide v 26/307 [8%] with methylprednisolone or prednisolone; OR 1.00, 95% CI 0.57 to 1.75). We found one RCT that examined the effects on bone mineral density of budesonide 9 mg daily and prednisolone 40 mg daily. [22] It found no significant difference in bone mineral density between budesonide and prednisolone, although people who received budesonide had smaller reductions in bone mineral density at 2 years (1 RCT, 98 corticosteroid-naïve people aged 20–70 years, CDAI greater than 150; bone mineral density change from baseline: –1.04% with budesonide v –3.84% with prednisolone; P = 0.084).
Top
Comment
Clinical guide:
In mild to moderate ileocaecal Crohn's disease, budesonide's favourable adverse-effect profile makes it preferable to methylprednisolone or prednisolone. [3] Both RCTs in the systematic review that compared the efficacy of budesonide versus placebo excluded people with disease extending beyond the hepatic flexure. [15] Of the five RCTs that compared the efficacy of budesonide versus that of methylprednisolone or prednisolone, only two included people with disease extending beyond the hepatic flexure. The efficacy of budesonide for colonic Crohn's disease is, therefore, less well established. Consequently, when ileocaecal disease is severe, or where there is extensive small bowel or colonic disease, methylprednisolone or prednisolone are often used because of their superior efficacy compared with budesonide. [3] Although one systematic review found no difference in adverse effects between budesonide and placebo in the short term, all corticosteroids have significant adverse effects with long-term or repeated use, and these must be weighed against the benefits of treatment while taking into account the recipient's wishes. [3] [15] [22]
References
3. Travis SP, Stange EF, Lemann M, et al. European evidence based consensus on the diagnosis and management of Crohn's disease: current management. Gut 2006;55(Suppl 1):i16–i35. [PubMed]
12. Summers RW, Switz DM, Sessions JT Jr, et al. National Cooperative Crohn's Disease Study: results of drug treatment. Gastroenterology 1979;77:847–869.
13. Malchow H, Ewe K, Brandes JW, et al. European Cooperative Crohn's Disease Study (ECCDS): results of drug treatment. Gastroenterology 1984;86:249–266.
14. Brignola C, De Simone G, Iannone P, et al. Influence of steroid treatment′s duration in patients with active Crohn's disease. Agents Actions 1992;Spec No:C90–C92. [PubMed]
15. Otley A, Steinhart AH. Budesonide for induction of remission in Crohn′s disease (Cochrane review). In: The Cochrane Library, Issue 1, 2007. Chichester, UK: John Wiley & Sons, Ltd. Search date not reported; primary sources Medline, plus hand searching, contact with relevant pharmaceutical companies and proceedings from major gastrointestinal meetings.
16. Greenberg GR, Feagan BG, Martin F, et al. Oral budesonide for active Crohn's disease. Canadian Inflammatory Bowel Disease Study Group. N Engl J Med 1994;331:836–841. [PubMed]
17. Campieri M, Ferguson A, Doe W, Persson T, Nilsson LG. Oral budesonide is as effective as oral prednisolone in active Crohn's disease. The Global Budesonide Study Group. Gut 1997;41:209–214. [PubMed]
18. Hofer KN. Oral budesonide in the management of Crohn's disease. [Review] [38 refs]. Ann Pharmacotherapy 2003/10;37:1457–1464.
19. Tremaine WJ, Hanauer SB, Katz S, et al. Budesonide CIR capsules (once or twice daily divided-dose) in active Crohn's disease: a randomized placebo-controlled study in the United States. Am J Gastroenterol 2002;97:1748–1754. [PubMed]
20. Herfarth H, Gross V, Andus T, et al. Analysis of the therapeutic efficacy of different doses of budesonide in patients with active Crohn's ileocolitis depending on disease activity and localization. Int J Colorectal Dis 2004;19:147–152. [PubMed]
21. Singleton JW, Law DH, Kelley ML Jr, Mekhjian HS, Sturdevant RA. National Cooperative Crohn's Disease Study: adverse reactions to study drugs. Gastroenterology 1979;77:870–882.
22. Schoon EJ, Bollani S, Mills PR, et al. Bone mineral density in relation to efficacy and side effects of budesonide and prednisolone in Crohn's disease. Clin Gastroenterol Hepatol 2005;3:113–121.
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1.
* Archives of Disease in Childhood
* [Original articles] Does polymeric formula improve adherence to liquid diet therapy in children with active Crohn's disease?
* Rodrigues, A F, Johnson, T, Davies, P, Murphy, M S
* http://adc.bmj.com/cgi/content/full/92/9/767?grp=1
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Found a backdoor that opened for that original article...here it is...Hugs,
Carrie
Medical treatments to induce remission in adults
Corticosteroids (oral) to induce remission
In this section:
Summary | Benefits | Harms | Comment
Top
Summary
One systematic review and two additional RCTs found that, compared with placebo, corticosteroids increased remission rates in active Crohn's disease, although remission rates for budesonide were slightly lower than for methylprednisolone and prednisolone. The optimal budesonide dose — and whether this should be given in a single or in two divided daily doses — remains unclear. One small RCT found similar remission rates between a 7-week and a 15-week tapering regimen of methylprednisolone. We found no evidence on the relative efficacy of methylprednisolone and prednisolone, or on different routes of administration. Two RCTs found that, compared with placebo, methylprednisolone and prednisolone increased adverse effects, including bleeding and infection. One systematic review found no significant difference in adverse effects between budesonide and placebo. The same review found that budesonide was associated with fewer adverse effects than methylprednisolone and prednisolone. One RCT found no significant difference in bone mineral density reduction between budesonide and prednisolone.
Top
Benefits
Methylprednisolone or prednisolone versus placebo:
We found no systematic reviews, but found two RCTs. [12] [13] The first RCT found that, compared with placebo, oral prednisolone 0.25–0.75 mg/kg daily (tapered over 17 weeks) significantly increased the proportion of people achieving clinical remission (defined as Crohn's Disease Activity Index [CDAI] score less than 150) at 17 weeks (1 RCT, 162 people, CDAI at least 150; Kaplan–Meier life table analysis: 24/40 [60%] with prednisolone v 17/57 [30%] with placebo; P less than 0.0001). [12] The second RCT found that, compared with placebo, oral methylprednisolone 48 mg daily (tapered over 6 weeks) significantly increased the proportion of people achieving clinical remission (defined as CDAI less than 150) at 18 weeks (1 RCT, 105 people aged at least 18 years, CDAI at least 150; AR 39/47 [83%] with methylprednisolone v 22/58 [38%] with placebo; P less than 0.05). [13]
Different methylprednisolone regimens:
We found no systematic reviews but found one RCT. [14] It found similar remission rates when methylprednisolone 40 mg daily for 3 weeks was tapered over 7 weeks compared with the same initial methylprednisolone dose tapered over 15 weeks. However, participant numbers were small (1 RCT, 54 people, CDAI 280–380; AR 22/27 [81%] after a 7-week course v 23/27 [85%] after a 15-week course; P value not reported).
Budesonide versus placebo:
We found one systematic review (search date 2005). [15] It found that, compared with placebo, budesonide 3–9 mg daily significantly increased the proportion of people who achieved remission at 8 weeks (2 RCTs, 324 people aged at least 18 years, with ileocolonic Crohn's disease not extending beyond the hepatic flexure; AR 109/218 [50%] with budesonide v 26/106 [25%] with placebo; OR 2.85, 95% CI 1.67 to 4.87). [15]
Different budesonide regimens versus each other:
We found one systematic review (search date 2002, 2 RCTs [16] [17] ) [18] and two additional RCTs. [19] [20] The first RCT identified by the review included four arms: 15 mg, 9 mg and 3 mg budesonide, and placebo, all given in two daily divided doses for 8 weeks. [16] It found that, compared with 3 mg budesonide and placebo, 9 mg and 15 mg budesonide significantly increased the proportion of people who achieved remission ( see table 1). The second RCT identified by the review found no significant difference in the proportion of people who achieved remission at 8 weeks between budesonide 9 mg daily in a single dose, budesonide 9 mg daily in two divided doses, and prednisolone 40 mg daily (reducing to 5 mg/day after 9 weeks) ( see table 1). [17] (Also see budesonide versus methylprednisolone or prednisolone below). The first additional RCT found no significant difference in the proportion of people who achieved remission at 8 weeks between budesonide 9 mg daily in a single dose, budesonide 9 mg daily in two divided doses, and placebo ( see table 1). [19] The second additional RCT compared 6 mg, 9 mg, and 18 mg budesonide (each in three daily divided doses). It found that, compared with 6 mg budesonide, the 9 mg and 18 mg dosages increased the proportion of people in remission at 6 weeks, although this reached significance only in the 18 mg group ( see table 1). [20]
Budesonide versus methylprednisolone or prednisolone:
We identified one systematic review (search date 2005). [15] It found that significantly fewer people achieved remission at 8 weeks with several budesonide regimens (3, 9, or 15 mg/day) than with prednisolone (40 mg daily tapering to 5 mg daily or 1 mg/kg tapering to 0.25 mg/kg daily) or with methylprednisolone (48 mg daily tapering to 8 mg daily; 5 RCTs, 667 people, CDAI greater than 150; AR 189/363 [52%] with budesonide v 186/304 [61%] with methylprednisolone and prednisolone; OR 0.69, 95% CI 0.51 to 0.95). (See also different budesonide regimens versus each other, above.)
Top
Harms
Methylprednisolone or prednisolone versus placebo:
We found two RCTs that gave information on adverse effects. [13] [21] The first RCT (119 people randomised to azathioprine, prednisolone, sulfasalazine, or placebo) found that prednisolone significantly increased petechial bleeding (6% v 0%; P less than 0.05), ecchymosis (17% v 3%; P less than 0.01), striae (6% v 0%; P less than 0.05), moon face (47% v 3%; P less than 0.01), acne (30% v 7%; P less than 0.01), hypertension (13% v 0%; P less than 0.01), and infection (27% v 10%; P less than 0.01) at 17 weeks compared with placebo. [21] It also found that prednisolone significantly reduced nausea and vomiting (38% v 19%; P less than 0.05) and anorexia (25% v 8%; P less than 0.01) at 17 weeks compared with placebo. The second RCT (452 people randomized to methylprednisolone, methylprednisolone plus sulfasalazine, sulfasalazine, or placebo for 6 weeks) found that methylprednisolone significantly increased the proportion of people with moon face at 2 years (2.51 per 100 participant months with methylprednisolone v 0.49 per 100 participant months with placebo; P less than 0.05) compared with placebo. [13]
Budesonide versus placebo or different budesonide regimens:
We found one systematic review (search date 2005). [15] It found no significant difference in adverse effects at 8 weeks between budesonide 3 mg, 9 mg, and 15 mg daily, and placebo (2 RCTs, 324 people; AR 115/220 [52%] with budesonide v 43/107 [40%] with placebo; OR 0.98, 95% CI 0.58 to1.67). [15]
Budesonide versus methylprednisolone or prednisolone:
We found one systematic review (search date 2005). [15] It found that budesonide significantly reduced the proportion of people with adverse effects compared with methylprednisolone or prednisolone (5 RCTs, 667 people; AR 136/364 [37%] with budesonide v 179/306 [58%] with conventional corticosteroids; OR 0.39, 95% CI 0.28 to 0.54). Budesonide also significantly reduced the proportion of people whose plasma cortisol levels were below the normal range (379 people; AR 81/229 [35%] with budesonide v 108/170 [64%] with conventional corticosteroids; OR 0.28, 95% CI 0.18 to 0.53). There was no significant difference between groups in the number of people who withdrew from the studies because of adverse effects (5 RCTs, 667 people; AR 37/362 [10%] with budesonide v 26/307 [8%] with methylprednisolone or prednisolone; OR 1.00, 95% CI 0.57 to 1.75). We found one RCT that examined the effects on bone mineral density of budesonide 9 mg daily and prednisolone 40 mg daily. [22] It found no significant difference in bone mineral density between budesonide and prednisolone, although people who received budesonide had smaller reductions in bone mineral density at 2 years (1 RCT, 98 corticosteroid-naïve people aged 20–70 years, CDAI greater than 150; bone mineral density change from baseline: –1.04% with budesonide v –3.84% with prednisolone; P = 0.084).
Top
Comment
Clinical guide:
In mild to moderate ileocaecal Crohn's disease, budesonide's favourable adverse-effect profile makes it preferable to methylprednisolone or prednisolone. [3] Both RCTs in the systematic review that compared the efficacy of budesonide versus placebo excluded people with disease extending beyond the hepatic flexure. [15] Of the five RCTs that compared the efficacy of budesonide versus that of methylprednisolone or prednisolone, only two included people with disease extending beyond the hepatic flexure. The efficacy of budesonide for colonic Crohn's disease is, therefore, less well established. Consequently, when ileocaecal disease is severe, or where there is extensive small bowel or colonic disease, methylprednisolone or prednisolone are often used because of their superior efficacy compared with budesonide. [3] Although one systematic review found no difference in adverse effects between budesonide and placebo in the short term, all corticosteroids have significant adverse effects with long-term or repeated use, and these must be weighed against the benefits of treatment while taking into account the recipient's wishes. [3] [15] [22]
References
3. Travis SP, Stange EF, Lemann M, et al. European evidence based consensus on the diagnosis and management of Crohn's disease: current management. Gut 2006;55(Suppl 1):i16–i35. [PubMed]
12. Summers RW, Switz DM, Sessions JT Jr, et al. National Cooperative Crohn's Disease Study: results of drug treatment. Gastroenterology 1979;77:847–869.
13. Malchow H, Ewe K, Brandes JW, et al. European Cooperative Crohn's Disease Study (ECCDS): results of drug treatment. Gastroenterology 1984;86:249–266.
14. Brignola C, De Simone G, Iannone P, et al. Influence of steroid treatment′s duration in patients with active Crohn's disease. Agents Actions 1992;Spec No:C90–C92. [PubMed]
15. Otley A, Steinhart AH. Budesonide for induction of remission in Crohn′s disease (Cochrane review). In: The Cochrane Library, Issue 1, 2007. Chichester, UK: John Wiley & Sons, Ltd. Search date not reported; primary sources Medline, plus hand searching, contact with relevant pharmaceutical companies and proceedings from major gastrointestinal meetings.
16. Greenberg GR, Feagan BG, Martin F, et al. Oral budesonide for active Crohn's disease. Canadian Inflammatory Bowel Disease Study Group. N Engl J Med 1994;331:836–841. [PubMed]
17. Campieri M, Ferguson A, Doe W, Persson T, Nilsson LG. Oral budesonide is as effective as oral prednisolone in active Crohn's disease. The Global Budesonide Study Group. Gut 1997;41:209–214. [PubMed]
18. Hofer KN. Oral budesonide in the management of Crohn's disease. [Review] [38 refs]. Ann Pharmacotherapy 2003/10;37:1457–1464.
19. Tremaine WJ, Hanauer SB, Katz S, et al. Budesonide CIR capsules (once or twice daily divided-dose) in active Crohn's disease: a randomized placebo-controlled study in the United States. Am J Gastroenterol 2002;97:1748–1754. [PubMed]
20. Herfarth H, Gross V, Andus T, et al. Analysis of the therapeutic efficacy of different doses of budesonide in patients with active Crohn's ileocolitis depending on disease activity and localization. Int J Colorectal Dis 2004;19:147–152. [PubMed]
21. Singleton JW, Law DH, Kelley ML Jr, Mekhjian HS, Sturdevant RA. National Cooperative Crohn's Disease Study: adverse reactions to study drugs. Gastroenterology 1979;77:870–882.
22. Schoon EJ, Bollani S, Mills PR, et al. Bone mineral density in relation to efficacy and side effects of budesonide and prednisolone in Crohn's disease. Clin Gastroenterol Hepatol 2005;3:113–121.
Close
Loading...
Web publication date: 07 Nov 2007 (based on March 2007 search)
Print page
Print review
Updates (new)
We provide up-to-the-minute updates for this review so you always have the latest evidence.
Related BMJ Journal articles
1.
* Archives of Disease in Childhood
* [Original articles] Does polymeric formula improve adherence to liquid diet therapy in children with active Crohn's disease?
* Rodrigues, A F, Johnson, T, Davies, P, Murphy, M S
* http://adc.bmj.com/cgi/content/full/92/9/767?grp=1
2.
* Gut
* European evidence-based consensus on the diagnosis and management of Crohn's disease
* Hanauer, S B; Sandborn, W J
* http://gut.bmj.com/cgi/content/full/56/2/161?grp=1
3.
* Postgraduate Medical Journal
* Immune-mediated inflammatory diseases (IMIDs) and biologic therapy: a medical revolution
* Kuek, Annabel; Hazleman, Brian L; Ostor, Andrew J K
* http://pmj.bmj.com/cgi/content/full/83/978/251?grp=1
4.
* Postgraduate Medical Journal
* Is rheumatoid arthritis a disease that starts in the intestine? A pilot study comparing an elemental diet with oral prednisolone
* Podas, Thrasyvoulos; Nightingale, Jeremy M D; Oldham, Roger; Roy, S; Sheehan, Nicholas J; Mayberry, John F
* http://pmj.bmj.com/cgi/content/full/83/976/128?grp=1
5.
* British Journal of Ophthalmology
* Adalimumab in the therapy of uveitis in childhood
* Biester, Sabine; Deuter, Christoph; Michels, Hartmut; Haefner, Renate; Kuemmerle-Deschner, Jasmin; Doycheva, Deshka; Zierhut, Manfred
* http://bjo.bmj.com/cgi/content/full/91/3/319?grp=1
Thanks Web Witch, 
The original reference on the budesonide data, (reference #20 in the report you quoted), contains a little more information about the treatment success percentages, etc., (plus a lot of info about the viability of other treatment regimens), but the statistics reported there, (66%, 55% and 36% achieving remission, when treatments with 18 mg, 9 mg, and 6 mg of budesonide were compared), are significantly lower than the results listed in the original AstraZeneca report that I was referring to. In the original report, the success statistics were listed as something like 75%, 65%, and 45%, to the best of my memory. I searched the AstraZeneca site pretty thoroughly, but since Prometheus Labs took over Entocort EC, the AstraZeneca site has apparently removed any and all remaining links to Entocort EC, (let alone profession level information on trial results).
http://www.wjgnet.com/1007-9327/14/354.asp
The Prometheus professional level information doesn't even mention anything more than a 9mg daily dose. <sigh>
Thanks for the info.
Hugs,
Tex
The original reference on the budesonide data, (reference #20 in the report you quoted), contains a little more information about the treatment success percentages, etc., (plus a lot of info about the viability of other treatment regimens), but the statistics reported there, (66%, 55% and 36% achieving remission, when treatments with 18 mg, 9 mg, and 6 mg of budesonide were compared), are significantly lower than the results listed in the original AstraZeneca report that I was referring to. In the original report, the success statistics were listed as something like 75%, 65%, and 45%, to the best of my memory. I searched the AstraZeneca site pretty thoroughly, but since Prometheus Labs took over Entocort EC, the AstraZeneca site has apparently removed any and all remaining links to Entocort EC, (let alone profession level information on trial results).
http://www.wjgnet.com/1007-9327/14/354.asp
The Prometheus professional level information doesn't even mention anything more than a 9mg daily dose. <sigh>
Thanks for the info.
Hugs,
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
Carrie,
Incidentally, did you happen to notice the subject of the article referenced in link number 4, toward the end of your post, concerning rheumatoid arthritis and the gut? I'm beginning to think that all autoimmune diseases are diet-connected. Only the abstract is available, but the results of that study were extremely interesting, to say the least:
http://pmj.bmj.com/cgi/content/abstract/83/976/128
Hugs,
Tex
Incidentally, did you happen to notice the subject of the article referenced in link number 4, toward the end of your post, concerning rheumatoid arthritis and the gut? I'm beginning to think that all autoimmune diseases are diet-connected. Only the abstract is available, but the results of that study were extremely interesting, to say the least:
http://pmj.bmj.com/cgi/content/abstract/83/976/128
Hugs,
Tex
It is suspected that some of the hardest material known to science can be found in the skulls of GI specialists who insist that diet has nothing to do with the treatment of microscopic colitis.
You are most welcome Sweetheart...glad I could be of assistance...I did happen to notice that about RA...very interesting...I have a sister with lupus and fibro and have been trying in vain to get her to go GF...I think there is a link between all of them and diet, we just need more info on it...
Off to research more of the higher dose of entocort..I'll report back with anything exciting...
Hugs,
C
Off to research more of the higher dose of entocort..I'll report back with anything exciting...
Hugs,
C