Corticosteroid-sparing treatments in patients with Crohn’s disease

Plevy, Scott E.
July 2002
American Journal of Gastroenterology;Jul2002, Vol. 97 Issue 7, p1607
Academic Journal
Conventional corticosteroid therapy effectively induces remission of Crohn’s disease (CD) across a range of disease severity. However, alternative treatments are needed for patients with disease unresponsive to corticosteroids, patients requiring maintenance therapy (for which corticosteroids are ineffective), corticosteroid-dependent patients, and patients with corticosteroid-related toxicities. Thus, corticosteroid-sparing effects are an important clinical endpoint for treatments of CD. Budesonide offers comparable efficacy with less short-term toxicity than conventional corticosteroids (prednisone, prednisolone); this agent has also demonstrated short-term remission maintenance efficacy, while potentially enabling withdrawal of more toxic corticosteroids in corticosteroid-dependent patients. However, budesonide has not shown long-term maintenance benefit in clinical studies, and the risk for and implications of budesonide dependency need further evaluation. The immunomodulators, azathioprine and 6-mercaptopurine, are most effective for maintenance of remission in quiescent disease, but may be useful in conjunction with other therapies in inducing remission in active CD; methotrexate may be considered an alternative because of its efficacy in inducing and maintaining remission. In clinical trials, treatment with azathioprine/6-methotrexate has enabled corticosteroid withdrawal in 55% of patients, and methotrexate, in 39% of patients with corticosteroid-dependent CD, while maintaining clinical response. Monitoring for infrequent hematological or hepatic toxicity is recommended during use of these immunomodulators. Infliximab is effective for induction and maintenance of remission in patients with refractory CD participating in randomized placebo-controlled studies and, in open-label experience, has enabled corticosteroid withdrawal in approximately three quarters of patients. This biological agent is generally well tolerated. Infusion reactions are the most commonly occurring side effects; such reactions may require adjustment of infusion rate and/or treatment with an antihistamine or acetaminophen. The investigational biological agent CDP-571 has also shown corticosteroid-sparing efficacy in patients with CD. In conclusion, recent research has helped identify corticosteroid-sparing treatments that can provide benefit in patients with corticosteroid-dependent and/or corticosteroid-refractory CD or patients at risk for corticosteroid-induced toxicities.


Related Articles

  • Prior bowel resections, perianal disease, and a high initial Crohn’s disease activity index are associated with corticosteroid resistance in active Crohn’s disease. Gelbmann, Cornelia M.; Rogler, Gerhard; Gross, Volker; Gierend, Michael; Bregenzer, Nicole; Andus, Tilo; Schölmerich, Jürgen // American Journal of Gastroenterology;Jun2002, Vol. 97 Issue 6, p1438 

    OBJECTIVES:Some patients with Crohn’s disease (CD) do not respond to corticosteroid therapy. Furthermore, corticosteroids frequently cause side effects. Thus, predictive parameters for treatment refractoriness would be helpful for treatment decisions.METHODS:A total of 300 patients with...

  • Budesonide (Entocort[sup ®] EC Capsules) Use of tradename is for product identification purposes only, and does not imply endorsement. Unless stated otherwise, the use of budesonide throughout this review refers to Entocort[sup ®] EC... McKeage, Kate; Goa, Karen L. // Drugs;2002, Vol. 62 Issue 15, p2263 

    Budesonide (Entocort® EC Capsules) is an oral corticosteroid with a high degree of topical activity and low systemic bioavailability (≈11%). This action is achieved by a high affinity for the glucocorticoid receptor and an extensive first-pass hepatic metabolism. The budesonide capsule...

  • Cost of Illness of Crohn's Disease. Bodger, K. // PharmacoEconomics;2002, Vol. 20, p639 

    Crohn's disease is a chronic inflammatory bowel disease of unknown aetiology which affects around 35 000 people in the UK (population 56.8 million). The potential for onset in early adult life, disease chronicity and a need for hospitalisation and surgery mean that the disease can be associated...

  • Infliximab retreatment in adults and children with Crohn’s disease: risk factors for the development of delayed severe systemic reaction. Kugathasan, Subra; Levy, Michael B.; Saeian, Kia; Vasilopoulos, Sotirios; Kim, Joseph P.; Prajapati, Devang; Emmons, Jeanne; Martinez, Alfonso; Kelly, Kevin J.; Binion, David G. // American Journal of Gastroenterology;Jun2002, Vol. 97 Issue 6, p1408 

    OBJECTIVES:Although effective in the treatment of refractory Crohn’s disease, episodic retreatment with the anti-tumor necrosis factor α chimeric monoclonal antibody infliximab (Remicade, Centocor, Malvern, PA) can be associated with severe acute and delayed systemic...

  • Digest. Richards, Derek // Evidence-Based Dentistry;Mar2000, Vol. 2 Issue 1, p29 

    Presents summaries of articles on dentistry published in various periodicals as of March 2000. Corticosteroid therapy and Crohn's disease; Amoxycillin and folate inhibitors for acute sinusitis.

  • Blepharoplasty for eyelid herniation in Crohn's disease. Katsanos, Konstantinos H.; Asproudis, Ioannis; Tsianos, Epameinondas V. // Annals of Gastroenterology;Jan2012, Vol. 25, p83 

    The article describes the case of a 53-year-old woman with long-term corticosteroid therapy for Crohn's disease who underwent cosmetic blepharoplasty. According to the patient, she suffered bilateral lower eyelid edema for ten years. Her Crohn's disease was initially treated with systemic...

  • Budenofalk.  // Royal Society of Medicine: Medicines;2002, p123 

    The article presents information on Budenofalk, a proprietary, prescription-only preparation of the corticosteroid budesonide. It can be used for the induction of remission in mild to moderate Crohn's disease affecting the ileum or ascending colon.

  • Crohn's disease patients find new relief from old drug. Karpa, Kelly Dowhower // Drug Topics;11/5/2001, Vol. 145 Issue 21, p16 

    Provides information on the treatment of Crohn's disease. Symptoms and complication of the disease; Utilization of salicylates, corticosteroids and budesonide; Effectiveness and side effects of the medications.

  • The pharmacologic management of Crohn's disease. Chan, Juliana // Formulary;Mar2008, Vol. 43 Issue 3, p93 

    Crohn's disease (CD) is a discontinuous transmural chronic inflammatory disorder involving any part of the lining of the gastrointestinal tract (GIT). In the majority of cases, the small intestine is primarily affected; however, inflammation can occur anywhere from the oral cavity to the anal...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics