Budesonide
- Budenofalk capsules containing gastro-resistant granules 3mg (£63.04 = 9mg daily)
- Entocort CR capsules containing modified-release gastro-resistant granules 3mg (£63.04 = 9mg once daily)
- Rectal foam enema, one metered application contains 2mg budesonide (£57.11 = 14 application canister)
- Orodispersible tablets sugar free 1mg
- Modified-release capsules 4mg
Indications and dose
- Budenofalk capsules and Entocort CR 3mg capsules are included for induction of remission in mild or moderate ileocecal Crohn's disease.
- Budenofalk: 9mg (three capsules) once daily or 3mg three times daily, for up to 8 weeks; reduce dose for the last 2 weeks of treatment
- Entocort CR: 9mg (three capsules) once daily in the morning for up to 8 weeks; reduce dose for the last 2–4 weeks of treatment
- Rectal foam is included for active ulcerative colitis affecting the sigmoid colon and rectum
- One metered application once daily for up to 8 weeks
- Orodispersible tablets sugar free (hospital only) are included for induction of remission in eosinophilic oesophagitis in line with NICE TA708 (see notes 2 & 3)
- Modified-release capsules (hospital only) are included for treating primary immunoglobulin A nephropathy (IgAN) in line with NICE TA937 (see note 4)
Notes
- Prescribe capsules by brand (to prevent confusion where multiple brands contain similar ingredients).
- Treatment with budesonide orodispersible tablets sugar free should be initiated by a physician with experience in the diagnosis and treatment of eosinophilic oesophagitis (Summary of Product Characteristics).
- NICE TA708: Budesonide as an orodispersible tablet sugar free is recommended as an option for inducing remission of eosinophilic oesophagitis (June 2021).
- NICE TA937: Targeted-release budesonide (Kinpeygo) is recommended as an option for treating primary immunoglobulin A nephropathy (IgAN) when there is a risk of rapid disease progression in adults with a urine protein-to-creatinine ratio of 1.5 g/g or more (December 2023), only if:
- it is an add-on to optimised standard care including the highest tolerated licensed dose of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), unless these are contraindicated and
- the company provides it according to the commercial arrangement.
Prednisolone
- Rectal solution 20mg in 100ml (£14.95 = 7 enemas)
- Suppositories 5mg (£249.64 = 10 suppositories)
Budesonide prolonged release (Cortiment)
The routine commissioning of budesonide 9mg prolonged release multi-matrix tablets used for up to 8 weeks treatment is not accepted in Devon for induction of remission in adults with mild to moderate active ulcerative colitis where 5-aminosalicylic acid (5-ASA) treatment is not sufficient (see Commissioning Policy for more details). The policy indicates that in exceptional circumstances the Trust-Managed Individual Patient Treatments process can be used for this indication.
Corticosteroids in Inflammatory Bowel Disease (IBD)
- Before starting steroids consider carefully if symptoms are due to active disease or other diagnosis e.g. co-existing irritable bowel syndrome. A raised CRP may help to confirm active disease.
- Avoid ultra-short or low doses. For the majority of patients start at prednisolone 40mg and decrease over 8 weeks.
- Steroids have no role in maintenance therapy.
- At one year, approximately 50% of patients with ulcerative colitis will be steroid dependent or steroid refractory.
Decision to start immunomodulator therapy for patients with ulcerative colitis will be made by gastroenterologist, typically if:
- More than one course of steroids in any 2 year period
- Following any severe attack requiring IV steroids