Inflammatory bowel diseases - Topically active corticosteroids [antikvár]

The use of glucocorticosteroids is still a mainstay of treatment of inflammatory bowel diseases. However, due to the ubiquitous presence of glucocorticosteroid receptors in almost every cell of the body, side-effects are rather frequent, and patients try to avoid steroid treatment. In order to overcome this problem topically active steroids have been developed for use in inflammatory bowel disease in analogy to those used in inflammatory disorders of the lung. The Workshop discussed the pharmacology of these steroids, and several clinical applications such as enema use for distal ulcerative colitis, the use of oral slow-release preparations for active Crohn's disease and for maintenance of Crohn's disease. The Workshop concluded with a summary, which dealt in particular with dosefinding problems. H.-W. Möllmann (Bochum) discussed the pharmacology and demonstrated data on the effects on circulating lymphocytes and leukocytes, showing that there is much less systemic activity of the newly developed steroids, in particular of budesonide. When equivalent doses for budesonide and 6-methylprednisolone were calculated it turnéd out that the application of 3 mg of budesonide in a pHdependent release formulation (Budenofalk®) was equivalent to the application of 0.48 mg of 6-methylprednisolone based on the effects on lymphocytes. Evidence from pharmacological studies favours budesonide over the other nonsystemic steroids. Á. Danielsson (Umeá) described the topicai use of budesonide in enema form for active distal ulcerative colitis. He presented data from several trials in which it was found that budesonide was superior to placebo (80 % versus 24 % remission rate) and equally effective as compared to conventional steroids when given as enemas. No suppression of morning plasma cortisol was found with a dose of 2 mg of budesonide daily; no side-effects were observed either. J. Schölmerich (Regensburg) discussed several trials on the use of budesonide in active Crohn's disease. Meanwhile, numerous trials (six with Budenofalk®) have been published in full or as abstract (in three of those systemic steroids were used as control group). Remission was achieved in 51-60% of patients with 9 mg of budesonide/day, while with systemic steroids remission rates of 60-73% were obtained. Side-effects involved 26-33% in the budesonide groups and 55-70 % in the conventional steroid groups; 9 mg of budesonide were effective compared to placebo. The data from the trials showed very striking concordance.