Influence of topically and systemically active steroids on circulating leukocytes in Crohn's disease.
OBJECTIVE
Budesonide, although only topically active, is effective in the treatment of Crohn's disease. This study was performed to compare the clinical efficacies of budesonide and prednisolone in relation to the activation status of circulating leukocytes.


METHODS
Twenty-four patients with active Crohn's disease were randomized to treatment with either budesonide or 6-methylprednisolone. Clinical response was monitored by the Crohn's disease activity index, C-reactive protein, and orosomucoid. Expression of CD25 and CD71 on T cells and CD64 on neutrophils was determined by flow cytometry. The release of TNF-alpha and IL-1beta by peripheral blood mononuclear cells was measured by ELISA.


RESULTS
After 2 wk of treatment a clinical response was observed in both groups, but it was more accentuated in patients treated with prednisolone. At baseline an upregulation of CD71 and CD64, but not CD25, was found in active patients. Prednisolone significantly decreased the expression of CD64 and the release of TNF-alpha and IL-1beta, but did not alter the expression of CD25 and CD71. Budesonide treatment failed to exert any effect on circulating leukocytes.


CONCLUSIONS
The inability of budesonide to downregulate activated circulating leukocytes may contribute to the somewhat lower clinical efficacy of this topical steroid in the treatment of active Crohn's disease.
Clinic of Internal Medicine IV, Department of Gastroenterology and Hepatology, University of Vienna, Austria.
W
W
Tillinger
C
C
Gasche
W
W
Reinisch
C
C
Lichtenberger
S
S
Bakos
C
C
Dejaco
G
G
Moser
H
H
Vogelsang
A
A
Gangl
H
H
Lochs
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use*; D003424:Crohn Disease / Q000188:drug therapy* / Q000276:immunology; D016207:Cytokines / Q000097:blood; D004311:Double-Blind Method; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007962:Leukocytes / Q000187:drug effects* / Q000276:immunology; D008213:Lymphocyte Activation / Q000187:drug effects; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use*; D009504:Neutrophils / Q000187:drug effects / Q000276:immunology
D000893:Anti-Inflammatory Agents; D016207:Cytokines; D019819:Budesonide; D008775:Methylprednisolone