Therapeutics and Drugs Briefs
Budesonide vs. Mesalamine for Crohn's Disease
Source: Thomsen OO, et al. N Engl J Med 1998;339:370-374.
Crohn's disease is commonly treated with glucocorticoids, which, though efficacious, are associated with significant steroid-induced side effects. Because of its high rate of first pass hepatic metabolism (90%), budesonide has a substantially lower systemic bioavailability than other currently popular steroids, without loss of its highly potent topical anti-inflammatory activity.
Slow-release granule formulations of budesonide allow prolonged drug contact with the ileal and ascending colon target sites. Thomsen et al compared slow-release mesalamine, another therapeutic choice in Crohn's, to budesonide.
Study subjects (n = 182) received either 9 mg budesonide qd or 2 g mesalamine bid for 16 weeks. Withdrawals due to worsening disease were almost three times more frequent in the group receiving mesalamine than those receiving budesonide. Adverse events resulting in discontinuation from the trial were almost twice as common among mesalamine subjects. The Crohn's remission rates were 62% for budesonide vs. 36% for mesalamine by 16 weeks. Ninety percent of patients who received budesonide maintained normal hypothalamic-pituitary-adrenal axis function as assessed by the cosyntropin challenge test. Budesonide appears to be a promising therapy for Crohn's disease.
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