Making the Switch from Systemic Steroids to Budesonide in Inactive Crohn's

Budesonide is a systemic glucocorticosteroid with topical anti-inflammatory effects and low systemic activity compared with conventional steroids. It undergoes about 90 percent first-pass metabolism to metabolites with little or no steroid activity. The controlled-release formulation is coated with Eudragit so that it is pH-controlled (similar to Asacol) and released in the ileum and right colon. In this multicenter European trial, researchers randomized 120 patients with steroid-dependent Crohn's disease in the ileum and right colon to receive budesonide (6 mg once daily) or placebo. All patients had failed at least 2 attempts to taper prednisone or prednisolone; these steroids were tapered (by 5 mg per week until reaching a dose of 20 mg,…