Second-Generation Corticosteroids for the Treatment of Crohn’s Disease and Ulcerative Colitis: More Effective and Less Side Effects?

Cassan, Chiara De; Fiorino, Gionata; Danese, Silvio

doi:10.1159/000338128

Cited by 65 publications

(52 citation statements)

References 113 publications

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“…Recent reviews have highlighted the safety and efficacy of second-generation glucocorticosteroids, particularly budesonide and BDP, in the treatment of Crohn's disease and ulcerative colitis [De Cassan et al 2012;Nunes et al 2012]. This review was undertaken to extend the discussion and report the safety and efficacy of these and other second-generation glucocorticosteroids (fluticasone and prednisolone metasulphobenzoate) in the treatment of IBD, including pouchitis and lymphocytic colitis.…”

Section: Overview Of Glucocorticosteroids In Inflammatory Bowel Diseamentioning

confidence: 99%

Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity

Prantera

Marconi

2013

Therap Adv Gastroenterol

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Inflammatory bowel diseases (IBDs) are a group of inflammatory conditions characterized by chronic, uncontrolled inflammation of the gastrointestinal tract. Reported prevalence is high in the United States and northern Europe, while the incidence varies greatly across the rest of Europe. Glucocorticosteroids are the standard treatment for IBD, but due to adverse events their use can be limited. However, new formulations of glucocorticosteroids have been developed to reduce systemic activation. The aim of this review was to assess and summarize the efficacy and safety of new formulations of glucocorticosteroids. A MEDLINE search identified publications focused on new formulations of nonsystemic steroidbased drugs for IBD and benefits and limitations of each of the new glucocorticosteroid formulations were identified. Budesonide has good efficacy and is an established treatment for Crohn's disease; it has been shown to be beneficial for the induction of remission in these patients, although it is not recommended for the maintenance of induced remission. Glucocorticosteroids are not recommended for the maintenance of remission in patients with IBD. However, a recent study suggested that beclomethasone dipropionate may be effective for prolonged treatment in patients in the postacute phase of Crohn's disease who were treated with a short course of systemic steroids. The efficacy of fluticasone propionate and prednisolone metasulphobenzoate in IBD is not well established given the small number of patients enrolled in the few published clinical trials. While the tolerability of these glucocorticosteroids is favourable, more research comparing these new agents with traditional systemic glucocorticosteroids is warranted.

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Section: Overview Of Glucocorticosteroids In Inflammatory Bowel Diseamentioning

confidence: 99%

Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity

Prantera

Marconi

2013

Therap Adv Gastroenterol

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“…Different drug categories are used for the management of IBD like aminosalicylates,83 corticosteroids,84 anti-tumor necrosis alpha (anti TNF-α) drugs,85,86 antibiotics,87,88 probiotics,89–91 and immunosuppressants 92,93. Because of a lack of desirable efficacy and poor tolerability of these drugs, surgical intervention may be indicated 94,95.…”

Section: Resultsmentioning

confidence: 99%

Inflammatory Bowel Disease: An Expanding Global Health Problem

M’Koma

2013

Clin Med Insights Gastroenterol

264

225

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This review provides a summary of the global epidemiology of inflammatory bowel diseases (IBD). It is now clear that IBD is increasing worldwide and has become a global emergence disease. IBD, which includes Crohn’s disease (CD) and ulcerative colitis (UC), has been considered a problem in industrial-urbanized societies and attributed largely to a Westernized lifestyle and other associated environmental factors. Its incidence and prevalence in developing countries is steadily rising and has been attributed to the rapid modernization and Westernization of the population. There is a need to reconcile the most appropriate treatment for these patient populations from the perspectives of both disease presentation and cost. In the West, biological agents are the fastest-growing segment of the prescription drug market. These agents cost thousands of dollars per patient per year. The healthcare systems, and certainly the patients, in developing countries will struggle to afford such expensive treatments. The need for biological therapy will inevitably increase dramatically, and the pharmaceutical industry, healthcare providers, patient advocate groups, governments and non-governmental organizations should come to a consensus on how to handle this problem. The evidence that IBD is now affecting a much younger population presents an additional concern. Meta-analyses conducted in patients acquiring IBD at a young age also reveals a trend for their increased risk of developing colorectal cancer (CRC), since the cumulative incidence rates of CRC in IBD-patients diagnosed in childhood are higher than those observed in adults. In addition, IBD-associated CRC has a worse prognosis than sporadic CRC, even when the stage at diagnosis is taken into account. This is consistent with additional evidence that IBD negatively impacts CRC survival. A continuing increase in IBD incidence worldwide associated with childhood-onset of IBD coupled with the diseases’ longevity and an increase in oncologic transformation suggest a rising disease burden, morbidity, and healthcare costs. IBD and its associated neoplastic transformation appear inevitable, which may significantly impact pediatric gastroenterology and adult CRC care. Due to an infrastructure gap in terms of access to care between developed vs. developing nations and the uneven representation of IBD across socioeconomic strata, a plan is needed in the developing world regarding how to address this emerging problem.

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“…Patients who there was no doubt had relapsed, by matching their symptom report to objective biochemical markers, were treated with escalation of therapy and in some cases glucocorticoids,19 in order to give the best possible chance of avoiding a hospital admission.…”

Section: Discussionmentioning

confidence: 99%

The financial impact of a nurse-led telemedicine service for inflammatory bowel disease in a large district general hospital

Squires

Boal

Naismith

2015

Frontline Gastroenterol

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IntroductionIt has become increasingly recognised that outpatient management is more cost-effective in inflammatory bowel disease (IBD). IBD Standards (Revised 2013) recommend telephone advice for patients with regard to symptoms and medication management. This report attempts to quantify the net financial impact of this service at our hospital since it was introduced in August 2013.MethodThe Royal Alexandra Hospital in Paisley (National Health Service, Greater Glasgow and Clyde) is a district general hospital with a catchment population of 200 000 with approximately 2500 patients with IBD. Data relating to the use of the IBD telemedicine service were prospectively recorded on a daily basis for a period of 5 months. We documented reasons for calling and the likely action taken by the patient had the telephone advice line not been available. Cost savings based on alternative outcomes were made in accordance with the Department of Health figures (Department of Health reference costs 2011–2012).ResultsThe mean number of calls per month was 88 (IQR 24)—(the mean number of calls which were deemed non-IBD issues was 30 calls per month (IQR 8.0)) The mean cost of staffing the IBD advice line with an IBD clinical nurse specialist was £482.00 per month (IQR 195.5). The mean time spent on calls per month was 28.5 h (IQR 11.5). Cost savings over 5 months for avoidance of general practitioner (GP) consultation was £3408.00. Savings for avoidance of a consultant appointment made over the 5-month period was £27 454.00. Savings made from patients avoiding either an accident and emergency (A&E) or a hospital admission were £540.00 and £11 488.00, respectively, over the 5-month period. The net saving was £42 890.00.ConclusionsA nurse-led telephone advice line appears to be a cost-effective intervention. It may prevent patients from unnecessary hospital attendance. Savings can be made to both primary care and secondary care. Overall, it appears that the advice line is providing a highly valuable service not just in terms of accessible treatment decisions and guidance for patients, but cost savings when IBD clinic nurse specialist time is compared with that of GPs, consultants or hospital facilities.

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Second-Generation Corticosteroids for the Treatment of Crohn’s Disease and Ulcerative Colitis: More Effective and Less Side Effects?

Cited by 65 publications

References 113 publications

Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity

Glucocorticosteroids in the treatment of inflammatory bowel disease and approaches to minimizing systemic activity

Inflammatory Bowel Disease: An Expanding Global Health Problem

The financial impact of a nurse-led telemedicine service for inflammatory bowel disease in a large district general hospital

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