Budesonide in the treatment of Crohn's disease. A meta-analysis

Papi, Claudio; Luchetti, R.; Gili, Loredana; Montanti, S.; Koch, Maurizio; Capurso, Lucio

doi:10.1016/s0016-5085(00)85266-x

Cited by 22 publications

(28 citation statements)

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“…The preventive use of conventional drugs such as budesonide has not proven efficacy [49] , although one single study suggested that this drug might be beneficial in those patients operated on for refractory inflammatory activity [50] . Despite they may be more appealing from a physiopathogenic point of view, neither the administration of anti-inflammatory cytokines such as interleukin-10 [51] , nor the use of probiotics [39,52,53] or a cocktail of probiotics and prebiotics [54] , have demonstrated to be superior to placebo in preventing POR in RCTs.…”

Section: Prevention Of Postoperative Recurrencementioning

confidence: 99%

Postoperative Crohn’s disease recurrence: A practical approach

Nos¹,

Domènech²

2008

WJG

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risk patients. Nitroimidazolic antibiotics, although efficient, are associated with a high rate of intolerance and might induce irreversible side effects when used for a long-term. Thiopurines are not widely used after ileocecal resection, maybe because some concerns in giving immunomodulators in asymptomatic patients still remain. In the era of biological agents and genetic testing, a well-established preventive strategy for POR is still lacking, and larger studies to identify good clinical, serological, and genetic predictors of early POR as well as more effective drugs (or drug combinations) are needed.

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Section: Prevention Of Postoperative Recurrencementioning

confidence: 99%

Postoperative Crohn’s disease recurrence: A practical approach

Nos¹,

Domènech²

2008

WJG

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“…Budesonide: Lower doses of budesonide (3 or 6 mg) have also been studied for their potential to be effective in the maintenance of remission. Although earlier metaanalyses have not shown that budesonide was superior over placebo [16,48] , a recent randomized, placebo-controlled trial found a trend towards a longer quiescent disease in budesonide treated patients compared to placebo [49] . In this trial, no significant difference in total adverse events or corticosteroid-associated events was demonstrated between placebo and budesonide.…”

Section: Maintenance Of Remissionmentioning

confidence: 91%

Conventional therapy for Crohn’s disease

Büning

Lochs²

2006

WJG

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Crohn's disease (CD) is a multifactorial disorder of unknown cause. Outstanding progress regarding the pathophysiology of CD has led to the development of innovative therapeutic concepts. Numerous controlled trials have been performed in CD over the last years. However, many drugs have not been approved by regulatory authorities due to lack of efficacy or severe side effects. Therefore, well-known drugs, including 5-ASA, systemic or topical corticosteroids, and immunosuppressants such as azathioprine, are still the mainstay of CD therapy. Importantly, biologicals such as infliximab have shown to be efficacious in problematic settings such as fistulizing or steroid-dependent CD. This review is intended to give practical guidelines to clinicians for the conventional treatment of CD. We concentrated on the results of randomized, placebo-controlled trials and meta-analyses, when available, that provide the highest degree of evidence. We provide evidence-based treatment algorithms whenever possible. However, many clinical situations have not been answered by controlled clinical trials and it is important to fill these gaps through expert opinions. We hope that this review offers a useful tool for clinicians in the challenging treatment of CD.

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“…29 A meta-analysis of budesonide failed to show any benefit for reduction of either endoscopic or clinical postoperative recurrence. 30 …”

Section: Prophylactic Medical Therapy For the Maintenance Of Postopermentioning

confidence: 99%

Postoperative Therapy for Crohnʼs Disease

Blum

Katz

2009

Inflammatory Bowel Diseases

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Prevention of the postoperative recurrence of Crohn's disease (CD) remains a challenging clinical problem. The majority of patients with CD will need surgery for treatment of the disease, most of these patients will develop recurrent symptoms within 5 years postoperatively, and many patients will need reoperation within 10 years. In patients with an ileocolic anastomosis, endoscopic recurrence precedes clinical recurrence and the severity of endoscopic recurrence correlates with the risk of clinical recurrence. Despite multiple studies, the best postoperative prophylactic therapy remains uncertain. Numerous randomized controlled trials of 5-aminosalicylates have shown only modest effect. Antibiotics, including metronidazole and ornidazole, decrease short-term, but not long-term endoscopic recurrence and are limited by side effects. Immunomodulators have yet to be extensively evaluated, although limited data suggest possible efficacy in preventing postoperative recurrence, particularly in high-risk patients. This review will evaluate the current state of the art therapy for postoperative prophylaxis in CD, with an emphasis on critical analysis of the available randomized controlled trials.

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Budesonide in the treatment of Crohn's disease. A meta-analysis

Cited by 22 publications

References 0 publications

Postoperative Crohn’s disease recurrence: A practical approach

Postoperative Crohn’s disease recurrence: A practical approach

Conventional therapy for Crohn’s disease

Postoperative Therapy for Crohnʼs Disease

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