Oral Steroids with Reduced Fluid Retention

Introduction to Budesonide MMX

The Toronto Consensus guidelines note that oral corticosteroid preparations with low systemic bioavailability, such as budesonide MMX, show efficacy while minimizing systemic adverse effects including edema 1, 2
Budesonide MMX and other second-generation corticosteroids have demonstrated efficacy for induction of remission with significantly fewer systemic corticosteroid adverse effects compared to prednisone 1, 2
Budesonide MMX undergoes extensive first-pass hepatic metabolism, resulting in lower systemic bioavailability and therefore less mineralocorticoid effect compared to systemically absorbed corticosteroids 1, 2

Pooled results from three trials comparing second-generation corticosteroids to oral prednisone showed no significant difference in inducing remission, but rates of steroid-related adverse events were significantly lower with second-generation corticosteroids 3
Approximately 50% of patients experience short-term corticosteroid-related adverse events including edema when treated with traditional oral corticosteroids 1, 2

For mild to moderate ulcerative colitis of any disease extent, budesonide MMX is suggested as an alternative first-line therapy to induce complete remission (GRADE: Weak recommendation, high-quality evidence) 1, 2
For patients with relative contraindications to high-dose corticosteroids, budesonide MMX should be strongly considered 4
Not all budesonide formulations are equivalent—the ileal-release preparations of budesonide were inferior to placebo and 5-ASA respectively, so specifically the MMX formulation should be used 1, 5
Budesonide MMX is primarily studied and indicated for inflammatory bowel disease; for other conditions requiring systemic corticosteroid therapy, traditional steroids may still be necessary despite their fluid retention effects 1, 2, 3