IBD Watch^®

^{Timely Information for Practicing Physicians}

  APRIL 2005 

Effects of budesonide and prednisolone on bone mineral density.  Corticosteroid therapy for CD is often complicated by osteoporosis.  Budesonide is a corticosteroid that is administered as a controlled-release capsule and has low systemic bioavailability.  Thus, Erik Schoon and others conducted a multicenter study of 272 patients with CD to compare the effects of budesonide and prednisolone on bone.  Among these patients were 98 patients with active disease who had never previously received corticosteroids (corticosteroid-naive), 83 patients with active disease who had previously received corticosteroids (corticosteroid-exposed), 90 patients with quiescent disease who were receiving long-term corticosteroids at baseline (corticosteroid-dependent), and 1 patient for which efficacy data were not obtained.  Patients were randomized to once-daily treatment with budesonide or prednisolone for 2 years at doses required to palliate disease activity.  Smaller reductions in bone mineral density developed in corticosteroid-naive patients treated with budesonide than in those treated with prednisolone (P = 0.0084).  No significant differences in bone mineral density were detected between the treatment groups within the corticosteroid-exposed or -dependent subpopulations.  Treatment-emergent corticosteroid side effects were less frequent in budesonide-treated patients.  These data showed that budesonide therapy, as compared with prednisolone treatment, resulted in greater bone mass preservation in only the subgroup of patients who had never previously received corticosteroids.  Efficacy was similar in both treatment groups.  (Schoon EJ, et al. Clin Gastroenterol Hepatol. 2005;3:113–121)

Pregnancy and disease activity.  F. Agret and colleagues retrospectively analyzed the effect of pregnancy on the activity of CD in 70 pregnancies that occurred in 61 women for whom the Harvey-Bradshaw index of disease activity had been regularly measured.  They found the mean Harvey-Bradshaw index to be lower during pregnancy than during the year preceding pregnancy (P = 0.03) or the year following delivery (P = 0.04).  The lower mean Harvey-Bradshaw index was largely due to improvements that occurred in smoking women, most of whom reduced tobacco consumption during pregnancy.  No significant changes in the mean Harvey-Bradshaw index were detected prior to pregnancy, during pregnancy, or following delivery in non-smoking women.  (Agret F, et al. Aliment Pharmacol &Ther. 2005;21:509–513) Editor’s comment: This study further supports the recommendations for Crohn's patients, and pregnant mothers in particular, to stop smoking.

Maintenance budesonide therapy.  S. Hanauer and coworkers conducted a double-blind, placebo-controlled study in which 110 CD patients in remission following treatment with budesonide 9 mg daily were randomized to receive budesonide 6 mg once daily or placebo for 52 weeks.  The median time to relapse was 360 days for budesonide-treated patients and 169 days for placebo-treated patients.  The relapse rate at 1 year was similar in both treatment groups.  Budesonide maintenance therapy was associated with a trend toward an increased time to relapse; however, no difference in the relapse rate at 1 year was detected between the two treatment groups.  (Hanauer S, et al. Aliment Pharmacol & Ther. 2005;21:363–371)

Familial Mediterranean fever gene prevalence.  CD has been reported to be more frequent among non–Ashkenazi Jewish patients. Functional similarities between the CD susceptibility gene (NOD2/CARD15) and the familial Mediterranean fever gene (MEVF) have been described. H. Fidder and colleagues analyzed 105 Israeli CD patients of non–Ashkenazi and mixed Ashkenazi ethnic background for MEVF mutations; 5 of these patients also had a clinical diagnosis of familial Mediterranean fever (FMF). MEVF mutations were detected in 13 (13%) non–FMF patients with CD and in all 5 FMF patients with CD.  Stricturing disease was found in 56% (10/18) of carriers of MEVF mutations, vs 25% of noncarriers (P = 0.015). In addition, extraintestinal manifestations were more frequent in carriers than in noncarriers (65% vs 32%). These findings demonstrated that, while MEVF mutations were not associated with CD susceptibility, the presence of these mutations was linked with a stricturing disease pattern and extraintestinal manifestations of CD. (Fidder H, et al. Am J Gastroenterol. 2005;100:338–343)

Oral methotrexate therapy.  J. Cummings and colleagues treated 42 UC patients who were unable to tolerate azathioprine (n=31) or did not benefit from azathioprine (n = 11) with oral methotrexate. Median duration of methotrexate therapy was 30 weeks; the mean dose of methotrexate was 19.9 mg/week. Complete steroid withdrawal for >3 months (remission) was achieved in 42% of patients. The authors also reported that a remission was induced in 7 of 8 other UC patients who had associated rheumatoid arthritis. Treatment was discontinued in 10% of patients due to side effects.  These results suggest that oral methotrexate is moderately effective in UC and is tolerated with acceptable toxicity.  (Cummings JRF, et al. Aliment Pharmacol & Ther. 2005;21:385–389)

Consensus conference.  The consensus recommendations of a panel of international experts for the performance of colorectal screening and surveillance in patients with IBD are presented in the March 2005 issue of Inflammatory Bowel Diseases.  (Itzkowitz S, et al. Inflamm Bowel Dis. 2005;11:314–321)

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