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Corticosteroids

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Pediatric Inflammatory Bowel Disease

Abstract

Glucocorticosteroids have an over 60-year history in the treatment of inflammatory bowel disease. The major anti-inflammatory effects of glucocorticoids appear to result from interactions between the activated glucocorticoid receptor and transcription factors that mediate the expression of inflammatory genes. Systemic corticosteroids continue to be used widely in the induction of remission of Crohn disease and ulcerative colitis. However, side effects, lack of mucosal healing, and lack of efficacy in the maintenance of remission limits their prolonged use. Topical corticosteroids such as budesonide have been developed and designed for controlled release in either the ileum (Entocort®) or colon (Uceris®). These formulations have efficacy in inducing remission in both Crohn disease and ulcerative colitis with fewer side effects than systemic corticosteroids.

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References

  1. Truelove SC, Witts LJ. Cortisone in ulcerative colitis; preliminary report on a therapeutic trial. Br Med J. 1954;2(4884):375–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Markowitz J, Grancher K, Kohn N, Lesser M, Daum F. A multicenter trial of 6-mercaptopurine and prednisone in children with newly diagnosed Crohn’s disease. Gastroenterology. 2000;119(4):895–902.

    Article  CAS  PubMed  Google Scholar 

  3. Barnes PJ, Adcock IM. How do corticosteroids work in asthma? Ann Intern Med. 2003;139(5 Pt 1):359–70.

    Article  CAS  PubMed  Google Scholar 

  4. Rhen T, Cidlowski JA. Antiinflammatory action of glucocorticoids–new mechanisms for old drugs. N Engl J Med. 2005;353(16):1711–23.

    Article  CAS  PubMed  Google Scholar 

  5. Hayashi R, Wada H, Ito K, Adcock IM. Effects of glucocorticoids on gene transcription. Eur J Pharmacol. 2004;500(1–3):51–62.

    Article  CAS  PubMed  Google Scholar 

  6. Heuschkel RB, Menache CC, Megerian JT, Baird AE. Enteral nutrition and corticosteroids in the treatment of acute Crohn’s disease in children. J Pediatr Gastroenterol Nutr. 2000;31(1):8–15.

    Article  CAS  PubMed  Google Scholar 

  7. Turner D, Travis SP, Griffiths AM, Ruemmele FM, Levine A, Benchimol EI, et al. Consensus for managing acute severe ulcerative colitis in children: a systematic review and joint statement from ECCO, ESPGHAN, and the Porto IBD Working Group of ESPGHAN. Am J Gastroenterol. 2011;106(4):574–88.

    Article  CAS  PubMed  Google Scholar 

  8. Turner D, Mack D, Leleiko N, Walters TD, Uusoue K, Leach ST, et al. Severe pediatric ulcerative colitis: a prospective multicenter study of outcomes and predictors of response. Gastroenterology. 2010;138(7):2282–91.

    Article  CAS  PubMed  Google Scholar 

  9. Pappa H, Thayu M, Sylvester F, Leonard M, Zemel B, Gordon C. Skeletal health of children and adolescents with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2011;53(1):11–25.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Beattie RM, Nicholls SW, Domizio P, Williams CB, Walker-Smith JA. Endoscopic assessment of the colonic response to corticosteroids in children with ulcerative colitis. J Pediatr Gastroenterol Nutr. 1996;22(4):373–9.

    Article  CAS  PubMed  Google Scholar 

  11. Ford AC, Bernstein CN, Khan KJ, Abreu MT, Marshall JK, Talley NJ, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(4):590–9. quiz 600

    Article  CAS  PubMed  Google Scholar 

  12. Steinhart AH, Ewe K, Griffiths AM, Modigliani R, Thomsen OO. Corticosteroids for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev. 2003;(4):CD000301.

    Google Scholar 

  13. Lennard-Jones JE, Misiewicz JJ, Connell AM, Baron JH, Jones FA. Prednisone as maintenance treatment for ulcerative colitis in remission. Lancet. 1965;1(7378):188–9.

    Article  CAS  PubMed  Google Scholar 

  14. Markowitz J, Hyams J, Mack D, Leleiko N, Evans J, Kugathasan S, et al. Corticosteroid therapy in the age of infliximab: acute and 1-year outcomes in newly diagnosed children with Crohn’s disease. Clin Gastroenterol Hepatol. 2006;4(9):1124–9.

    Article  CAS  PubMed  Google Scholar 

  15. Hyams J, Markowitz J, Lerer T, Griffiths A, Mack D, Bousvaros A, et al. The natural history of corticosteroid therapy for ulcerative colitis in children. Clin Gastroenterol Hepatol. 2006;4(9):1118–23.

    Article  CAS  PubMed  Google Scholar 

  16. Faubion Jr WA, Loftus Jr EV, Harmsen WS, Zinsmeister AR, Sandborn WJ. The natural history of corticosteroid therapy for inflammatory bowel disease: a population-based study. Gastroenterology. 2001;121(2):255–60.

    Article  CAS  PubMed  Google Scholar 

  17. Ho GT, Chiam P, Drummond H, Loane J, Arnott ID, Satsangi J. The efficacy of corticosteroid therapy in inflammatory bowel disease: analysis of a 5-year UK inception cohort. Aliment Pharmacol Ther. 2006;24(2):319–30.

    Article  CAS  PubMed  Google Scholar 

  18. Targownik LE, Nugent Z, Singh H, Bernstein CN. Prevalence of and outcomes associated with corticosteroid prescription in inflammatory bowel disease. Inflamm Bowel Dis. 2014;20(4):622–30.

    Article  PubMed  Google Scholar 

  19. Dilger K, Alberer M, Busch A, Enninger A, Behrens R, Koletzko S, et al. Pharmacokinetics and pharmacodynamic action of budesonide in children with Crohn’s disease. Aliment Pharmacol Ther. 2006;23(3):387–96.

    Article  CAS  PubMed  Google Scholar 

  20. Lundin PD, Edsbacker S, Bergstrand M, Ejderhamn J, Linander H, Hogberg L, et al. Pharmacokinetics of budesonide controlled ileal release capsules in children and adults with active Crohn’s disease. Aliment Pharmacol Ther. 2003;17(1):85–92.

    Article  CAS  PubMed  Google Scholar 

  21. Levine A, Weizman Z, Broide E, Shamir R, Shaoul R, Pacht A, et al. A comparison of budesonide and prednisone for the treatment of active pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2003;36(2):248–52.

    Article  CAS  PubMed  Google Scholar 

  22. Escher JC. Budesonide versus prednisolone for the treatment of active Crohn’s disease in children: a randomized, double-blind, controlled, multicentre trial. Eur J Gastroenterol Hepatol. 2004;16(1):47–54.

    Article  CAS  PubMed  Google Scholar 

  23. Brunner M, Vogelsang H, Greinwald R, Kletter K, Kvaternik H, Schrolnberger C, et al. Colonic spread and serum pharmacokinetics of budesonide foam in patients with mildly to moderately active ulcerative colitis. Aliment Pharmacol Ther. 2005;22(5):463–70.

    Article  CAS  PubMed  Google Scholar 

  24. Fiorino G, Fries W, De La Rue SA, Malesci AC, Repici A, Danese S. New drug delivery systems in inflammatory bowel disease: MMX and tailored delivery to the gut. Curr Med Chem. 2010;17(17):1851–7.

    Article  CAS  PubMed  Google Scholar 

  25. Brunner M, Ziegler S, Di Stefano AF, Dehghanyar P, Kletter K, Tschurlovits M, et al. Gastrointestinal transit, release and plasma pharmacokinetics of a new oral budesonide formulation. Br J Clin Pharmacol. 2006;61(1):31–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Levine A, Broide E, Stein M, Bujanover Y, Weizman Z, Dinari G, et al. Evaluation of oral budesonide for treatment of mild and moderate exacerbations of Crohn’s disease in children. J Pediatr. 2002;140(1):75–80.

    Article  CAS  PubMed  Google Scholar 

  27. Otley A, Leleiko N, Langton C, Lerer T, Mack D, Evans J, et al. Budesonide use in pediatric crohn’s disease. J Pediatr Gastroenterol Nutr. 2012;55(2):200–4.

    Article  PubMed  Google Scholar 

  28. Rezaie A, Kuenzig ME, Benchimol EI, Griffiths AM, Otley AR, Steinhart AH, et al. Budesonide for induction of remission in Crohn’s disease. Cochrane Database Syst Rev. 2015;(6):CD000296.

    Google Scholar 

  29. Rutgeerts P, Lofberg R, Malchow H, Lamers C, Olaison G, Jewell D, et al. A comparison of budesonide with prednisolone for active Crohn’s disease. N Engl J Med. 1994;331(13):842–5.

    Article  CAS  PubMed  Google Scholar 

  30. Bar-Meir S, Chowers Y, Lavy A, Abramovitch D, Sternberg A, Leichtmann G, et al. Budesonide versus prednisone in the treatment of active Crohn’s disease. Israeli Budesonide Study Group. Gastroenterology. 1998;115(4):835–40.

    Article  CAS  PubMed  Google Scholar 

  31. Gross V, Andus T, Ecker KW, Raedler A, Loeschke K, Plauth M, et al. Low dose oral pH modified release budesonide for maintenance of steroid induced remission in Crohn’s disease. The Budesonide Study Group. Gut. 1998;42(4):493–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Campieri M, Ferguson A, Doe W, Persson T, Nilsson LG. Oral budesonide is as effective as oral prednisolone in active Crohn’s disease. The Global Budesonide Study Group. Gut. 1997;41(2):209–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Ruemmele FM, Veres G, Kolho KL, Griffiths A, Levine A, Escher JC, et al. Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn’s disease. J Crohns Colitis. 2014;8(10):1179–207.

    Article  CAS  PubMed  Google Scholar 

  34. Dignass A, Van Assche G, Lindsay JO, Lemann M, Soderholm J, Colombel JF, et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: current management. J Crohns Colitis. 2010;4(1):28–62.

    Article  CAS  PubMed  Google Scholar 

  35. Levine A, Watemberg N, Hager H, Bujanover Y, Ballin A, Lerman-Sagie T. Benign intracranial hypertension associated with budesonide treatment in children with Crohn’s disease. J Child Neurol. 2001;16(6):458–61.

    Article  CAS  PubMed  Google Scholar 

  36. Kundhal P, Zachos M, Holmes JL, Griffiths AM. Controlled ileal release budesonide in pediatric Crohn disease: efficacy and effect on growth. J Pediatr Gastroenterol Nutr. 2001;33(1):75–80.

    Article  CAS  PubMed  Google Scholar 

  37. Greenberg GR, Feagan BG, Martin F, Sutherland LR, Thomson AB, Williams CN, et al. Oral budesonide as maintenance treatment for Crohn’s disease: a placebo-controlled, dose-ranging study. Canadian Inflammatory Bowel Disease Study Group. Gastroenterology. 1996;110(1):45–51.

    Article  CAS  PubMed  Google Scholar 

  38. Lofberg R, Rutgeerts P, Malchow H, Lamers C, Danielsson A, Olaison G, et al. Budesonide prolongs time to relapse in ileal and ileocaecal Crohn’s disease. A placebo controlled one year study. Gut. 1996;39(1):82–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Ferguson A, Campieri M, Doe W, Persson T, Nygard G. Oral budesonide as maintenance therapy in Crohn's disease–results of a 12-month study. Global Budesonide Study Group. Aliment Pharmacol Ther. 1998;12(2):175–83.

    Article  CAS  PubMed  Google Scholar 

  40. Kuenzig ME, Rezaie A, Seow CH, Otley AR, Steinhart AH, Griffiths AM, et al. Budesonide for maintenance of remission in Crohn’s disease. Cochrane Database Syst Rev. 2014;(8):CD002913.

    Google Scholar 

  41. Sandborn WJ, Bosworth B, Zakko S, Gordon GL, Clemmons DR, Golden PL, et al. Budesonide foam induces remission in patients with mild to moderate ulcerative proctitis and ulcerative proctosigmoiditis. Gastroenterology. 2015;148(4):740–50.e2.

    Article  CAS  PubMed  Google Scholar 

  42. Rubin DT, Sandborn WJ, Bosworth B, Zakko S, Gordon GL, Sale ME, et al. Budesonide foam has a favorable safety profile for inducing remission in mild-to-moderate ulcerative proctitis or proctosigmoiditis. Dig Dis Sci. 2015;60(11):3408–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Hartmann F, Stein J, BudMesa-Study G. Clinical trial: controlled, open, randomized multicentre study comparing the effects of treatment on quality of life, safety and efficacy of budesonide or mesalazine enemas in active left-sided ulcerative colitis. Aliment Pharmacol Ther. 2010;32(3):368–76.

    Article  CAS  PubMed  Google Scholar 

  44. D’Haens GR, Kovacs A, Vergauwe P, Nagy F, Molnar T, Bouhnik Y, et al. Clinical trial: preliminary efficacy and safety study of a new Budesonide-MMX(R) 9 mg extended-release tablets in patients with active left-sided ulcerative colitis. J Crohns Colitis. 2010;4(2):153–60.

    Article  PubMed  Google Scholar 

  45. Travis SP, Danese S, Kupcinskas L, Alexeeva O, D’Haens G, Gibson PR, et al. Once-daily budesonide MMX in active, mild-to-moderate ulcerative colitis: results from the randomised CORE II study. Gut. 2014;63(3):433–41.

    Article  CAS  PubMed  Google Scholar 

  46. Sandborn WJ, Danese S, D'Haens G, Moro L, Jones R, Bagin R, et al. Induction of clinical and colonoscopic remission of mild-to-moderate ulcerative colitis with budesonide MMX 9 mg: pooled analysis of two phase 3 studies. Aliment Pharmacol Ther. 2015;41(5):409–18.

    Article  CAS  PubMed  Google Scholar 

  47. Sandborn WJ, Travis S, Moro L, Jones R, Gautille T, Bagin R, et al. Once-daily budesonide MMX(R) extended-release tablets induce remission in patients with mild to moderate ulcerative colitis: results from the CORE I study. Gastroenterology. 2012;143(5):1218–26.e1–2.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Washington University School of Medicine, 1 Children’s Place, CB 8116, St Louis, MO, 63110, USA

    Charles M. Samson MD

  2. Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, University Medical Center, Dr Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands

    Johanna C. Escher MD, PhD

Authors
  1. Charles M. Samson MD
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  2. Johanna C. Escher MD, PhD
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Corresponding author

Correspondence to Johanna C. Escher MD, PhD .

Editor information

Editors and Affiliations

  1. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Petar Mamula

  2. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Andrew B. Grossman

  3. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Robert N. Baldassano

  4. Division of GI, Hepatology & Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

    Judith R. Kelsen

  5. Division of Pediatric Gastroenterology & Nutrition, University of South Carolina School of Medicine - Greenville, Greenville, South Carolina, USA

    Jonathan E. Markowitz

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Samson, C.M., Escher, J.C. (2017). Corticosteroids. In: Mamula, P., Grossman, A., Baldassano, R., Kelsen, J., Markowitz, J. (eds) Pediatric Inflammatory Bowel Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-49215-5_29

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  • DOI: https://doi.org/10.1007/978-3-319-49215-5_29

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