Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2 (COX-2), and NF-κB (Nuclear factor kappa B), curbing the inflammatory response.
Prednisone, methylprednisolone, and hydrocortisone are the primary glucocorticoids used. Prednisone is almost exclusively given orally, and, while methylprednisolone and hydrocortisone can also be given orally, in severe cases they are given intravenously. These drugs target the entire gastrointestinal tract, inducing remission effectively, but have limitations for long-term use due to significant adverse effects such as skin thinning, cardiovascular events, and psychiatric disturbances.
Budesonide (Pulmacort), another glucocorticoid, is available in oral, rectal, and controlled-release formulations. Oral budesonide is used for ileocecal Crohn's disease, while rectal formulations are preferred for diseases limited to the rectum and left colon. It exhibits high first-pass hepatic metabolism, resulting in low systemic bioavailability and fewer side effects than conventional glucocorticoids. However, its efficacy in achieving clinical remission may be slightly lower than prednisolone.
Dal capitolo 23:
Now Playing
Drugs for Chronic Bowel Disorders
57 Visualizzazioni
Drugs for Chronic Bowel Disorders
172 Visualizzazioni
Drugs for Chronic Bowel Disorders
83 Visualizzazioni
Drugs for Chronic Bowel Disorders
81 Visualizzazioni
Drugs for Chronic Bowel Disorders
78 Visualizzazioni
Drugs for Chronic Bowel Disorders
55 Visualizzazioni
Drugs for Chronic Bowel Disorders
71 Visualizzazioni