Early Oral & Topical Anti-inflammatory Therapies for IBD
Budesonide / Bausch Health Canada Inc. (2020)
Induction of remission in patients with mild-to-moderate distal ulcerative colitis extending up to 40 cm from the anal verge.
Rectal foam
Rectal foam
2 mg/actuation or metered dose.
One metered dose rectally twice daily for 2 weeks followed by 1 metered dose once daily for 4 weeks; may be extended an additional 2 weeks if symptoms persist.
No pediatric data, provider judgement.
RCTs: randomized clinical trials, IV: intravenous, BDP: beclomethasone dipropionate
For more detailed information regarding side effects, please refer to the appropriate product monograph.
• Hyperglycemia
• Adrenocortical insufficiency
• Acne vulgaris
• Agitation
• Allergic dermatitis
• Mood changes
• Hypertension
• Insomnia
IBD: inflammatory bowel disease
No data are available to Health Canada and therefore it is not authorized for pediatric use.
Turner D. et al. suggest12:
Rectal steroid preparations are useful for patients who are 5-ASA intolerant. Meta-analysis data consistently supports the superiority of rectal mesalamine over rectal steroids.
Second-generation topical steroids have a more favourable safety profile and may be considered before systemic steroids.
There is insufficient and inadequate data in clinical studies for patients age 65 and older. Should be used with caution.
Recommendations14:
Topical corticosteroids may be effective for distal colonic disease but may be poorly tolerated in older patients with limited mobility or weak sphincter tone.
The Global Consensus Statement on the management of Pregnancy in Inflammatory Bowel Disease by Mahadevan, U. et al suggest16:
Controlling disease activity during pregnancy among women with inflammatory bowel disease is critical to reduce adverse outcomes.
The recommendations emphasize the importance of controlling disease activity before and during pregnancy with steroid sparing therapy.
Guidelines suggest,
“Rectal corticosteroids have not demonstrated benefit over topical aminosalicylates for clinical, endoscopic, or histologic outcomes, but there is no increased safety concern.”
The Global Consensus Statement on the management of Pregnancy in Inflammatory Bowel Disease by Mahadevan, U. et al suggest16:
IBD: inflammatory bowel disease, 5-ASA: 5-aminosalicylic acid, ECCO: European Crohn’s and Colitis Organization, EEN: enteral nutrition