Document Detail


Second-generation corticosteroids for the treatment of Crohn's disease and ulcerative colitis: more effective and less side effects?.
MedLine Citation:
PMID:  22796798     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background/Aims: Systemic corticosteroids are highly effective at inducing clinical remission in cases of acute exacerbation of Crohn's disease (CD) and ulcerative colitis (UC); however, their use is limited by their frequent and sometimes severe side effects. Thus, a second generation of corticosteroids with less systemic effects has been developed. This review analyzed all of the studies on the new formulations of steroids with limited absorption (budesonide, budesonide MMX®, beclomethasone dipropionate and erythrocyte-mediated delivery of dexamethasone) in patients with CD and UC. Methods: All relevant articles published in English between September 1960 and April 2011 were reviewed. Results: Budesonide is superior to placebo, and as effective as systemic corticosteroids in inducing clinical remission in patients with ileo-colonic CD, but evidence of mucosal healing is limited. When administered as an MMX formula, budesonide can also effectively induce clinical remission in patients with UC, but budesonide alone is not effective in maintaining clinical remission in CD or UC. Beclomethasone dipropionate seems to be effective in patients with mild-to-moderate left-sided and extensive UC, while data on erythrocyte-mediated delivery of dexamethasone are encouraging but still limited. The safety profile for all these products is good but more studies are needed. Conclusion: Steroids remain the mainstay for the induction of clinical remission in cases of acute relapse of both CD and UC. Second-generation corticosteroids are an interesting alternative, with the advantage of high topical activity, less systemic toxicity and limited side effects.
Authors:
Chiara De Cassan; Gionata Fiorino; Silvio Danese
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Publication Detail:
Type:  Journal Article     Date:  2012-07-12
Journal Detail:
Title:  Digestive diseases (Basel, Switzerland)     Volume:  30     ISSN:  1421-9875     ISO Abbreviation:  Dig Dis     Publication Date:  2012  
Date Detail:
Created Date:  2012-07-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8701186     Medline TA:  Dig Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  368-75     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 S. Karger AG, Basel.
Affiliation:
IBD Center, Milan, Italy.
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