Therapeutic Options For Patients With Inflammatory Bowel Disease: New Steroids

Glucocorticoids are the mainstay of the medical management of inflammatory bower disease (IBD) (Crohn's disease and ulcerative colitis). The pronounced immunosuppressive capacity of these drugs is closely related to downregulation of gene expression of proinflammatory and immunoregulatory cytokines which are produced in increased amounts in active IBD. The well-known side effects of glucocorticoid treatment have prompted the development of a new class of glucocorticoids with high topical selectivity for bowel mucosa partly due to high first-pass hepatic metabolism. Budesonide is the only new steroid which has been extensively developed for the treatment of inflammatory bower disease. Budesonide enemas are as effective as conventional glucocorticoids in the treatment of patients with distal ulcerative colitis, but with less adrenal gland suppression. Budesonide controlled ileal release (CIR) capsules, which deliver the active drug at the ileocecal region, are superior to placebo and only slightly less effective than oral prednisolone in the treatment of active Crohn's, but have less glucocorticoid-associated side effects. A similar sustained release formulation for oral treatment of extensive ulcerative colitis is in the development phase. These formulations of budesonide with topical selectivity for inflamed disease sites seem to represent a real step forward in the management of selected subgroups of patients with inflammatory bowel disease.