Budesonide for the treatment of ulcerative colitis.
Budesonide for the treatment of ulcerative colitis.
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DOI：
10.1080/14656566.2016.1183648
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发表时间：
2016-08
影响因子：
3.2
通讯作者：
Herfarth H
中科院分区：
文献类型：
--
作者：
Abdalla MI;Herfarth H
布地奈德是一种合成的皮质类固醇，其特征在于增强的局部效力和有限的全身生物利用度。它在溃疡性结肠炎（UC）中的应用仅限于直肠制剂，直到最近引入了新的口服布地奈德制剂，该制剂采用了多基质系统技术。本综述的目的是评价目前口服和直肠布地奈德在治疗UC患者中的作用。在本文中，我们描述了不同口服和直肠布地奈德制剂的化学结构和药理学特征，提供了已发表的评价布地奈德治疗UC的有效性和安全性的试验的总结，并讨论了布地奈德在这一人群中的应用现状，布地奈德可有效诱导轻中度UC患者的缓解。然而，目前的证据表明口服布地奈德劣于5-氨基水杨酸盐（5-阿萨）和全身性类固醇，而直肠应用与其他直肠类固醇制剂相当，但仍劣于直肠5-阿萨。在临床实践中，有几个问题需要澄清，包括它在诱导剂中的确切位置;联合布地奈德和5-ASA的作用;联合口服和直肠布地奈德的作用;以及布地奈德在维持治疗中的作用。
Budesonide is a synthetic corticosteroid characterized by enhanced topical potency and limited systemic bioavailability. Its use in ulcerative colitis (UC) was limited to rectal preparations until recently when the new oral budesonide formulation incorporating the multi-matrix system technology was introduced. The purpose of this review is to evaluate the current role of oral and rectal budesonide in managing UC patients In this paper, we described the chemical structure and pharmacologic characteristics of the different oral and rectal budesonide preparations, provided a summary of the published trials that evaluated the efficacy and safety of budesonide in UC, and discussed the current status of its use in this population Budesonide is effective in inducing remission in a subset of patients with mild-moderate UC. Nevertheless, the current evidence suggests inferiority of oral budesonide to 5-aminosalisylates (5-ASA) and systemic steroids, whereas rectal applications are comparable to other rectal steroid preparations but still inferior to rectal 5-ASA. In clinical practice, several issues need clarification including, its exact position in the line of induction agents; the role of combining budesonide and 5-ASAs; the role of combining oral and rectal budesonide; and the role of budesonide in maintenance therapy.