23.7 : グルココルチコイドを使用した炎症性腸疾患におけるクローン病の治療薬

Glucocorticoids, like prednisone, are potent anti-inflammatory agents that induce effective remission in Crohn's patients.

These bind and activate nuclear receptors, which translocate to the nucleus and interact with glucocorticoid response elements on DNA.

This interaction inhibits the transcription of proinflammatory cytokines such as TNF and inflammatory mediators such as NF-κB and phospholipase A₂.

Common glucocorticoids used for treatment are prednisone, methylprednisolone, hydrocortisone, and budesonide.

Prednisone is usually administered orally, while severe cases may require intravenous methylprednisolone.

Hydrocortisone can be delivered via enemas or suppositories to target inflammation in the rectum and sigmoid colon, providing localized relief.

Budesonide, an analog of prednisolone, is often used in an enteric-release formulation that minimizes first-pass hepatic metabolism to treat ileocecal inflammation.

The prolonged use of glucocorticoids is discouraged due to potential adverse effects, including osteoporosis, arrhythmia, anxiety, and gastritis.