PMID- 30656288
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220331
IS  - 2515-2092 (Electronic)
IS  - 2515-2084 (Print)
IS  - 2515-2084 (Linking)
VI  - 1
IP  - 4
DP  - 2018 Dec
TI  - Budesonide for the Induction and Maintenance of Remission in Crohn's Disease: 
      Systematic Review and Meta-Analysis for the Cochrane Collaboration.
PG  - 159-173
LID - 10.1093/jcag/gwy018 [doi]
AB  - BACKGROUND: Budesonide is an oral glucocorticoid designed for the treatment of 
      inflammatory bowel disease (IBD) that may reduce systemic adverse events (AEs). 
      This review examined the efficacy and safety of budesonide for the induction and 
      maintenance of clinical remission in Crohn's disease (CD). METHODS: MEDLINE, 
      EMBASE, other electronic databases, reference lists and conference proceedings 
      were searched to November 2017 to identify randomized controlled trials of 
      budesonide. Outcomes were the induction and maintenance of remission at eight 
      weeks and one year, respectively, as well as corticosteroid-related AEs and 
      abnormal adrenocorticotropic hormone (ACTH) tests. Pooled relative risks (RRs) 
      and 95% confidence intervals (CIs) were estimated using random effects models. 
      RESULTS: Thirteen induction and 10 maintenance trials were included. Budesonide 9 
      mg/day was more effective than placebo (RR 1.93; 95% CI, 1.37-2.73; GRADE: 
      moderate) but less effective than conventional steroids (RR 0.85; 95% CI, 
      0.75-0.97; GRADE: moderate) to induce remission. Corticosteroid-related AEs 
      occurred less often with induction doses of budesonide than steroids (RR 0.64; 
      95% CI, 0.54-0.76; GRADE: moderate); budesonide did not increase AEs relative to 
      placebo (RR 0.97; 95% CI, 0.76-1.23; GRADE: moderate). Budesonide 6 mg/day was 
      not different from placebo for maintaining remission (RR 1.13; 95% CI, 0.94-1.35; 
      GRADE: moderate). Both induction (GRADE: low for 3 mg/day, moderate for 9 mg/day) 
      and maintenance budesonide treatment (GRADE: very low for 3 mg/day, low for 6 
      mg/day) increased the risk of an abnormal ACTH test compared with placebo, but 
      less than conventional steroids (GRADE: very low for both induction and 
      maintenance). CONCLUSION: For induction of clinical remission, budesonide was 
      more effective than placebo, but less effective than conventional steroids. 
      Budesonide was not effective for the maintenance of remission. Budesonide was 
      safer than conventional steroids, but the long-term effects on the adrenal axis 
      and bone health remain unknown.
FAU - Kuenzig, M Ellen
AU  - Kuenzig ME
AUID- ORCID: 0000-0002-3984-8426
AD  - CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology & 
      Nutrition, Children's Hospital of Eastern Ontario, Ontario, Ottawa, Canada.
FAU - Rezaie, Ali
AU  - Rezaie A
AD  - Department of Medicine, Division of Gastroenterology, Cedars-Sinai Medical 
      Center, Los Angeles, California, USA.
FAU - Kaplan, Gilaad G
AU  - Kaplan GG
AD  - Department of Medicine, University of Calgary, Calgary, Canada.
AD  - Department of Community Health Sciences, University of Calgary, Calgary, Canada.
FAU - Otley, Anthony R
AU  - Otley AR
AD  - Division of Gastroenterology, IWK Health Centre, Dalhousie University, Halifax, 
      Nova Scotia, Canada.
FAU - Steinhart, A Hillary
AU  - Steinhart AH
AD  - Department of Medicine, Division of Gastroenterology, Mount Sinai Hospital, 
      Toronto, Ontario, Canada.
FAU - Griffiths, Anne Marie
AU  - Griffiths AM
AD  - Division of Gastroenterology, Hepatology & Nutrition, The Hospital for Sick 
      Children, Toronto, Ontario, Canada.
FAU - Benchimol, Eric I
AU  - Benchimol EI
AUID- ORCID: 0000-0001-8855-3598
AD  - CHEO Inflammatory Bowel Disease Centre, Division of Gastroenterology Hepatology & 
      Nutrition, Children's Hospital of Eastern Ontario, Ontario, Ottawa, Canada.
AD  - Department of Pediatrics and School of Epidemiology and Public Health, University 
      of Ottawa, Ottawa, Canada.
FAU - Seow, Cynthia H
AU  - Seow CH
AUID- ORCID: 0000-0002-1551-9054
AD  - Department of Medicine, University of Calgary, Calgary, Canada.
AD  - Department of Community Health Sciences, University of Calgary, Calgary, Canada.
LA  - eng
PT  - Journal Article
DEP - 20180524
PL  - England
TA  - J Can Assoc Gastroenterol
JT  - Journal of the Canadian Association of Gastroenterology
JID - 101738684
PMC - PMC6328928
OTO - NOTNLM
OT  - Budesonide
OT  - Corticosteroids
OT  - Crohn's disease
OT  - Induction and maintenance of remission
OT  - Meta-analysis
EDAT- 2019/01/19 06:00
MHDA- 2019/01/19 06:01
PMCR- 2018/05/24
CRDT- 2019/01/19 06:00
PHST- 2019/01/19 06:00 [entrez]
PHST- 2019/01/19 06:00 [pubmed]
PHST- 2019/01/19 06:01 [medline]
PHST- 2018/05/24 00:00 [pmc-release]
AID - gwy018 [pii]
AID - 10.1093/jcag/gwy018 [doi]
PST - ppublish
SO  - J Can Assoc Gastroenterol. 2018 Dec;1(4):159-173. doi: 10.1093/jcag/gwy018. Epub 
      2018 May 24.