[Budesonide in inflammatory bowel disease: a meta-analysis]

Area of Science:

• Gastroenterology
• Pharmacology
• Clinical Medicine

Background:

• Budesonide, a synthetic glucocorticoid, is utilized for managing Crohn's disease (CD) and ulcerative colitis (UC).
• The study aimed to assess budesonide's efficacy in inducing and maintaining CD remission orally and inducing endoscopic/histologic remission in distal UC via enema.

Purpose of the Study:

• To evaluate the efficacy of oral budesonide in inducing and maintaining remission in Crohn's disease patients.
• To assess the efficacy of budesonide enema in inducing endoscopic and histologic remission in patients with distal ulcerative colitis.

Main Methods:

• A systematic review and meta-analysis of controlled clinical trials were conducted using the Peto method.
• Data from eight studies on CD (four for induction, four for maintenance) and four studies on UC were analyzed.

Main Results:

• For CD induction, budesonide (9 mg/d) showed similar clinical remission rates to prednisolone (40-46 mg/d) but with fewer adverse events and lower impact on serum cortisol.
• For CD maintenance, budesonide at 3 mg/d and 6 mg/d did not show significant differences compared to placebo.
• In UC, budesonide demonstrated no significant difference in endoscopic remission rates compared to conventional glucocorticoids.

Conclusions:

• Budesonide is a viable alternative to prednisolone for active CD induction, offering a better safety profile regarding cortisol levels.
• The evaluated dosage of budesonide is not effective for maintaining remission in CD.
• Budesonide is as effective as conventional glucocorticoids for inducing remission in UC.