Hold the Foam: Why Topical Budesonide Remains Relevant for IBD Therapy
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EDITORIAL
Hold the Foam: Why Topical Budesonide Remains Relevant for IBD Therapy Luca Pastorelli1,2 · Cristina Bezzio3 · Simone Saibeni3
© Springer Science+Business Media, LLC, part of Springer Nature 2020
The last two decades have witnessed radical changes in the treatment for inflammatory bowel disease (IBD), with an explosion of monoclonal antibody-based ‘biologic’ drugs targeting components of the immune system. As a consequence, treatment strategies have rapidly evolved, aiming at increasingly ambitious targets. Despite these major advances, therapy remains far from optimal since achieving and maintaining remission continues to be challenging in many patients. Thus, since IBD treatment can be far from satisfactory for both physicians and patients, it is not surprising that translational and clinical investigation is focused on intestinal inflammation. Though there is a great interest in developing new drugs and exploiting novel mechanisms to treat IBD, the majority of IBD patients suffer from mild-to-moderately active disease that does not require more aggressive, costly, and potentially harmful therapy. In these cases, significant efforts should also be made in order to improve and maximize the efficacy of already available therapies. For example, molecules with low systemic impact such as 5-aminosalicylates and low-bioavailability topical corticosteroids act directly on inflamed mucosa without achieving significant concentrations in the systemic circulation; these drugs greatly benefit from different administration routes, formulations, and drug delivery systems, which enhance the exposure of therapeutic molecules to the diseased sites. Moreover, in ulcerative colitis patients needing stronger treatments, topical therapies are important adjunctive treatments since symptoms related to distal inflammation (e.g., * Simone Saibeni [email protected] 1
Gastroenterology Unit, IRCCS Policlinico San Donato, San Donato Milanese, MI, Italy
2
Department of Biomedical Sciences for Health, University of Milan, Milan, MI, Italy
3
Gastroenterology Unit, Rho Hospital, ASST Rhodense, Corso Europa 250, 20017 Rho, MI, Italy
urgency, tenesmus, incontinence, soiling) significantly worsen quality-of-life. Nevertheless, several factors, such as retention problems, unpleasant feeling, rectal/abdominal pain, and flatulence, may limit the adherence to rectal therapies. As a consequence, more comfortable and acceptable topical formulations are welcome in order to further improve adherence with consequent increased efficacy. Budesonide is a synthetic nonhalogenated glucocorticoid related to triamcinolone hexacetonide, developed in order to reduce systemic side effects from steroids. Oral formulations of budesonide are used in mild-to-moderately active Crohn’s disease and ulcerative colitis. Indeed, clinical trials demonstrated the efficacy and safety of topical budesonide formulations in treating active distal forms of IBD, namely ulcerative colitis [1]. Since budesonide foams, it is preferred over enemas by patients [
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