IBD Curriculum Topic 6.1-6.11

Budesonide is a corticosteroid that has low systemic bioavailability due to high first-pass metabolism in the liver. It is effective for inducing remission in mild ileal and ileocaecal Crohn’s disease.

Benefit & risk (Crohn's disease)

Response and remission

  • After 8 weeks of treatment, budesonide is significantly more effective than placebo (RR 1.96, 95% CI&nsbp;1.19 to 3.23) or mesalamine (RR 1.63; 95%CI 1.23 to 2.16) to induce remission.
  • Although it is less effective than prednisolone (RR 0.86) its better safety profile makes it use preferable

Maintenance of remission

  • Budesonide may delay relapse after medically induced remission, but is not effective at maintaining remission by 12 months.

Prevention of relapse post surgery

  • There is no evidence to support a role in preventing post-operative relapse.

Major side effects

  • Fewer side effects than prednisolone (RR 0.64, occur in 33% and of less severe nature cf. 55% taking prednisolone).
  • National Formularly should be consulted to review adverse drug reactions and drug interactions.

Dose and administration

  • 9mg PO od (e.g. 9mg PO od for two months then 3 mg PO od for one month)
  • Consider adjunct vitamin D / Ca++.

Special situations

Pregnancy and lactation

  • It is not known whether budesonide is safe in pregnancy
  • Toxic doses in animal studies are teratogenic therefore it should be avoided.

Terms and conditions

By using this site you acknowledge that the content of this website is based on a review process of the ECCO Consensus Guidelines and primarily aims at facilitating their visualization.

Any treatment decisions are a matter for individual clinicians and may not be based primarily on the e-Guide content.

The European Crohn's and Colitis Organisation and/or any of its staff members and/or any website contributor may not be held liable for any information published in good faith on this website.

You agree that the use of this website is at your own risk and hereby waive any and all potential claims against European Crohn's and Colitis Organisation, and/or any of its staff members and/or any of the website contributors.