Oral budesonide in gastrointestinal and liver disease: A practical guide for the clinician

Abstract

Oral budesonide is a second-generation steroid that allows local, selective treatment of the gastrointestinal tract and the liver, minimizing systemic exposure. The results of randomized trials comparing budesonide versus placebo or active comparators have led to expert recommendations that budesonide be used to treat mild or moderate active ileocecal Crohn's disease, microscopic colitis (including both collagenous and lymphocytic colitis), ulcerative colitis, and non-cirrhotic autoimmune hepatitis. The mechanism of budesonide action obviates the need for dose tapering due to safety reasons after induction therapy. Where low-dose budesonide is used to maintain remission, usually in microscopic colitis, it does not appear to have adverse safety implications other than slight reductions in cortisol levels on rare occasions. As a gut-selective and liver-selective corticosteroid, budesonide offers an appealing alternative to conventional systemic glucocorticoids in diseases of these organs.

Budesonide as induction therapy for incomplete microscopic colitis: A randomised, placebo‐controlled multicentre trial

“… 11 Even so, the results cannot be extrapolated to all individuals with MCi. In this trial, budesonide was administered using pH‐modified release oral granules (Budenofalk ® ) which release the active ingredient only at pH 6.4 or higher, 47 that is, specifically in the target areas terminal ileum and colon. Thus, the current results may not be applicable to other budesonide formulations with a different release profile.…”

Budesonide-Induced Hyperosmolar Hyperglycemic State Following Transjugular Intrahepatic Portosystemic Shunt

“…Although it has a high first-pass metabolism, prolonged use of budesonide may result in mild suppres- sion of adrenal glucocorticoid generation but no hemodynamically or endocrinologically significant side effect has been described in the usual clinical circumstances (2,(18)(19)(20). In contrast, typical systemic steroid side effects such as iatrogenic Cushing syndrome have been described in circumstances where the metabolism of budesonide was slowed by inhibitors to cytochrome P-450 such as ritonavir, fluvoxamine, and azoles (21,22).…”

Autoimmune Hepatitis: a Review of Established and Evolving Treatments

“…Nevertheless, budesonide established itself as a first-line alternative to prednisolone in current guidelines, such as by the AASLD or DGVS [29,32]. Budesonide was repeatedly associated with fewer steroid-specific side effects compared to prednisolone, namely osteopenia [45] and adrenal suppression [46].…”

“…On a final note, budesonide may not be administered to patients with cirrhosis. These patients have a higher rate of treatment failure and increase of systemic side effects potentially due to an altered metabolism and porto-systemic shunting as well as risk of hepatic vein thrombosis [46][47][48].…”