Cochrane Summaries

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Oral budesonide for the treatment of ulcerative colitis

Sherlock ME, Seow CH, Steinhart AH, Griffiths AM
Published Online: 
10 August 2011

Inflammatory bowel disease consists of 2 main subtypes; ulcerative colitis (UC) and Crohn's disease (CD). Ulcerative colitis is a chronic, relapsing and remitting, inflammatory condition affecting the large bowel. Traditional corticosteroids are often used in the treatment of moderate to severe, active UC. However, traditional corticosteroids are associated with a wide range of side-effects. Budesonide is a steroid, but it is rapidly metabolized by the body and therefore has less side-effects than traditional corticosteroids. We know that oral budesonide has a role in the treatment of some patients with CD and it has also shown beneficial effects when used as an enema for UC, when only the distal colon is involved. The purpose of this review was to examine the effectiveness of oral budesonide for the treatment of UC. We found three studies that were eligible for inclusion in this review. Although the side-effect profile of budesonide is better than that of prednisolone, there is no evidence to recommend the use of oral budesonide for active UC. There are 2 large ongoing trials which will provide further information regarding the potential effectiveness of oral budesonide for the treatment of active UC. One of the included studies compared budesonide with mesalamine (a 5-ASA drug). This study provides high quality evidence that mesalamine is superior to budesonide for the treatment of active ulcerative colitis.