A Cochrane review «Budesonide for induction of remission in Crohn's disease»1 «Rezaie A, Kuenzig ME, Benchimol EI et al. Budesonide for induction of remission in Crohn's disease. Cochrane Database Syst Rev 2015;6():CD000296. . »1 included 14 studies with 1805 patients. 9 compared budesonide with conventional corticosteroids, 3 were placebo-controlled, and 2 compared budesonide with mesalamine. After 8 weeks of treatment, budesonide was significantly more effective than placebo. 47% (115/246) of budesonide patients achieved remission at 8 weeks compared to 22% (29/133) of placebo patients (RR 1.93, 95% CI 1.37 to 2.73; 3 studies, 379 patients). 69 % (107/154) of budesonide patients were in remission at 8 weeks compared to 62% (132/242) of mesalamine patients (RR 1.12, 95% CI 0.95 to 1.32). Budesonide was significantly less effective than conventional steroids for induction of remission at eight weeks. Fifty-two per cent of budesonide patients achieved remission at week 8 compared to 61% of patients who received conventional steroids (RR 0.85, 95% CI 0.75 to 0.97; 8 studies, 750 patients). Budesonide was significantly less effective than conventional steroids among patients with severe disease (CDAI > 300) (RR 0.52, 95% CI 0.28 to 0.95).
Fewer adverse events occurred in those treated with budesonide compared to conventional steroids (RR 0.64, 95% CI 0.54 to 0.76) and budesonide was better able to preserve adrenal function (RR for abnormal ACTH test 0.65, 95% CI 0.55 to 0.78).