Beclometasone dipropionate: a topically active corticosteroid for the treatment of gastrointestinal graft-versus-host disease.
BACKGROUND
Acute graft-versus-host disease (GVHD) is one of the most severe complications following allogeneic transplantation and the involvement of the gut has been associated with increased mortality and a poorer response to transplant. The use of systemic corticosteroids remains the standard first-line treatment, despite their severe secondary effects.


OBJECTIVE
Beclometasone dipropionate (BDP) is a topically active corticosteroid with low absorption into the systemic circulation, which minimises many of the deleterious side effects associated with systemic corticosteroids.


RESULTS
Phase II and III trials evaluating the efficacy of BDP were reviewed. In the Phase II trials, 77% of patients with gastrointestinal GVHD who received BDP as a single agent responded and 50% did not require systemic corticosteroids, thus avoiding prolonged exposure to prednisone. Randomised trials demonstrated that BDP is safe and effective in treating acute gastrointestinal GVHD when used with a short induction course of prednisone, reducing the risk of GVHD treatment failure by > 60% and reducing mortality one year after randomisation by 45%.


CONCLUSIONS
These results provide a particularly strong rationale for the incorporation of steroid-sparing regimens such as oral BDP in acute GVHD treatment.
Díez-Campelo
María
M
Hospital Universitario de Salamanca, Servicio de Hematología, Paseo de San Vicente 58-182, 37007 Salamanca, Spain.
Sánchez-Guijo
Fermín M
FM
Pérez-Simón
José A
JA
Simón
José A Pérez
JA
D000305:Adrenal Cortex Hormones / Q000737:chemistry / Q000627:therapeutic use*; D001507:Beclomethasone / Q000737:chemistry / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004361:Drug Tolerance; D064420:Drug-Related Side Effects and Adverse Reactions; D041981:Gastrointestinal Tract / Q000187:drug effects*; D006086:Graft vs Host Disease / Q000145:classification / Q000188:drug therapy*; D006801:Humans
D000305:Adrenal Cortex Hormones; D001507:Beclomethasone