Budesonide as Effective as Prednisolone in Relieving Symptoms of Rheumatoid Arthritis

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Budesonide as Effective as Prednisolone in Relieving Symptoms of Rheumatoid

Arthritis

05/27/2004

By Emma Hitt, PhD

Budesonide and prednisolone appear to relieve symptoms of rheumatoid

arthritis shortly after initiation of treatment for at least 3 months. In

addition, no rebound occurs after cessation of treatment, according to the

findings of a new randomised trial.

Budesonide controlled ileal release (CIR), a locally acting glucocorticoid

with minimal systemic exposure, could potentially normalise and modify the

intestinal immune response and thereby indirectly induce and maintain

control of the joint inflammation over and above the effect of systemically

available glucocorticoids, say the researchers.

R. Kirwan, MD, with the Academic Rheumatology Unit, University Division

of Medicine, at the Bristol Royal Infirmary, United Kingdom, and colleagues

compared budesonide, a locally acting glucocorticoid with minimal systemic

exposure, with conventional glucocorticoid treatment and placebo in 143

patients with active rheumatoid arthritis.

The double blind, randomised trial was conducted over 12 weeks. Patients

received budesonide 3 mg daily, budesonide 9 mg daily, prednisolone 7.5 mg

daily, or placebo. The pattern of clinical response and changes in the 4

week period following discontinuation of treatment were observed.

Tender joint count and swollen joint count were both reduced in patients

taking budesonide 9 mg compared with those taking placebo (28% for tender

and 34% for swollen joint counts, P < .05). Similar results were observed

for prednisolone 7.5 mg, but budesonide 3 mg was less effective.

Of the patients, 25% on placebo, 22% on budesonide 3 mg, 42% on budesonide 9

mg, and 56% on prednisolone 7.5 mg met the American College of Rheumatology

(ACR)20 response criteria.

Response to budesonide 9 mg and prednisolone 7.5 mg was observed by 2 weeks

and reached a maximum at 8 weeks. Budesonide and prednisolone appeared to

control symptoms in a similar manner. Furthermore, symptoms did not appear

to worsen after discontinuation of either glucocorticoid treatment.

Adverse effects typical of glucocorticoids were equally common in all

groups. Adverse events causing the patient to discontinue the study were few

and included gastrointestinal symptoms, heart symptoms, and mood

swings/insomnia.

" Our results suggest there was no additional effect of budesonide over and

above the systemic benefits of glucocorticoid treatment, in spite of a

presumed strong local effect on the terminal ileum, " Dr. Kirwan and

colleagues conclude.

Ann Rheum Dis 2004;63:688-695