Corticosteroids (prednisone, prednisolone, budesonide)
These drugs have very potent anti-inflammatory properties, and are used in a wide variety of inflammatory conditions. Corticosteroids inhibit pro-inflammatory cytokine production: IL-1, IL-2, the IL-2 receptor, IFN-alpha, TNF-alpha, and colony stimulating factors (CSFs) such as IL-3. Moreover, even in very low concentrations they inhibit the synthesis of a variety of pro-inflammatory enzymes, including the macrophage products collagenase, elastase and plasminogen activator.
In Crohn's disease corticosteroids are prescribed in large doses when the symptoms are severe, but as the symptoms are getting controlled, the dosage is lowered. Corticosteroids have been shown to be effective for induction, but not maintenance of remission in Crohn's disease (Stange EF et al, 2006)Stange EF, Travis SP, et al European Crohn's and Colitis Organization. European evidence based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis. Gut. 2006 Mar;55 Suppl 1:i1-15..
Side effects
Side effects of corticosteroids include fluid retention, edema, weight gain, high blood pressure, osteoporosis, hypopotassemia, headache, muscle weakness, hirsutism, acne, thinning and easy bruising of the skin, glaucoma, cataracts, peptic ulceration, worsening of diabetes, irregular menses, iatrogenic Cushing, growth retardation in children, convulsions, and psychic disturbances. Psychic disorders can include depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behavior. Corticosteroids also suppress the body's cortisol production and cannot be stopped abruptly. They are not for long-term use, but may be used to control flares. Budesonide (Entocort) may have fewer side effects due to its specific delivery to the gastrointestinal tract, with limited systemic bioavailability. It is a safer alternative to conventional corticosteroids and of proven efficacy in the induction of remission in mild to moderate Crohn's disease. However, budesonide is not effective in maintaining remission in patients with Crohn's disease (Benchimol EI et al, 2009)Benchimol EI, Seow CH, et al. Budesonide for maintenance of remission in Crohn's disease. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD002913. Review.