From the Guidelines
Budesonide is recommended as a first-line treatment for mild-to-moderate Crohn's disease and microscopic colitis at a dose of 9 mg once daily for up to 8 weeks, due to its efficacy in inducing remission and its favorable safety profile compared to other corticosteroids. The use of budesonide in inflammatory bowel disease is supported by multiple studies, including a randomized double-blind trial that showed its effectiveness in inducing remission in patients with mild-to-moderate ileocaecal Crohn's disease 1. Additionally, the American Gastroenterological Association (AGA) recommends budesonide as a first-line treatment for microscopic colitis, citing its superiority over mesalamine and other treatments in inducing clinical remission 1. The European Crohn's and Colitis Organisation (ECCO) also recommends budesonide for the induction of clinical remission in patients with active mild-to-moderate Crohn's disease limited to the ileum and/or ascending colon 1.
Some key points to consider when using budesonide include:
- The dose of 9 mg once daily is as effective as 3 mg three times daily 1
- Budesonide should be tapered over 1-2 weeks when remission has been achieved 1
- Maintenance therapy with budesonide may be considered for patients with microscopic colitis who have had a clinical relapse after cessation of induction therapy, with a recommended dose of 6 mg daily 1
- Patients should be monitored for potential side effects, including throat irritation, nasal dryness, headache, and nausea, and should rinse their mouth after using inhaled budesonide to prevent oral thrush 1
Overall, the evidence supports the use of budesonide as a safe and effective treatment for mild-to-moderate Crohn's disease and microscopic colitis, with a favorable safety profile compared to other corticosteroids.
From the FDA Drug Label
1 INDICATIONS AND USAGE Budesonide extended-release tablets are indicated for the induction of remission in patients with active, mild to moderate ulcerative colitis.
INDICATIONS AND USAGE Budesonide extended-release tablets are a glucocorticosteroid indicated for the induction of remission in patients with active, mild to moderate ulcerative colitis. ( 1)
- Indication: Budesonide is indicated for the induction of remission in patients with active, mild to moderate ulcerative colitis 2 2.
- Key use: The primary use of budesonide is to treat ulcerative colitis.
From the Research
Budesonide Overview
- Budesonide is a glucocorticoid with high topical activity and low systemic bioavailability, resulting in reduced systemic effects compared to other glucocorticoids 3.
- It is used to treat inflammatory bowel disease, asthma, and rhinitis.
Therapeutic Efficacy
- In patients with active distal ulcerative colitis and/or proctitis, budesonide enema treatment produced endoscopic remission or improvement in 46 to 84% of patients 3.
- Oral treatment with controlled release budesonide produced clinical remission in 42 to 67% of patients with active Crohn's disease 3.
- Budesonide is effective in controlling mild-to-moderate persistent asthma in patients aged 12 months and older 4.
- It is also used to treat seasonal allergic and perennial rhinitis, where it is more effective than disodium cromoglycate and at least as effective as beclomethasone dipropionate 5.
Safety and Tolerability
- Budesonide has a low incidence of adverse glucocorticoid-related effects, making it a favorable option for longer-term maintenance therapy 3.
- It does not affect hypothalamic-pituitary-adrenal axis function, bone mineral density, cataract formation, or final adult height in patients with mild or moderate persistent asthma 4.
- Budesonide has been demonstrated to be well tolerated in the treatment of chronic asthma in patients as young as 12 months 4.