Budesonide induction and maintenance therapy for Crohnʼs disease during pregnancy

Authors:
  • AAAshwin N. Ananthakrishnan
    Ashwin N. Ananthakrishnan
  • MIMazen Issa
    Mazen Issa
  • LRLydia Rosenbaum
    Lydia Rosenbaum
  • SSSue Skaros
    Sue Skaros
  • JNJulianne R. Newcomer
    Julianne R. Newcomer
  • RKRandall S. Kuhlmann
    Randall S. Kuhlmann
  • MOMary F. Otterson
    Mary F. Otterson
  • JEJeanne Emmons
    Jeanne Emmons
  • JKJosh Knox
    Josh Knox
  • DBDavid G. Binion
    David G. Binion
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Abstract
There is no standard approach for the medical management of Crohn's disease (CD) during pregnancy and there is limited data regarding safety and efficacy of the treatments. Budesonide (Entocort EC, AstraZeneca) is an enteric coated locally acting glucocorticoid preparation whose pH- and time-dependent coating enables its release into the ileum and ascending colon for the treatment of mild to moderate Crohn's disease. There is no available data on the safety of using oral budesonide in pregnant patients. We reviewed our Inflammatory Bowel Disease (IBD) center database to identify patients with CD who received treatment with budesonide for induction and/or maintenance of remission during pregnancy and describe the maternal and fetal outcomes in a series of eight mothers and their babies. The mean age of the patients was 27.7 years. All patients had small bowel involvement with their CD. The disease pattern was stricturing in 6 patients, fistulizing in 1 and inflammatory in 1 patient. Budesonide was used at the 6 mg/day dose in 6 patients and 9 mg/day dose in 2 patients. The average treatment duration ranges from 1-8 months. There were no cases of maternal adrenal suppression, glucose intolerance, ocular side effects, hypertension or fetal congenital abnormalities. Budesonide may be a safe option for treatment of CD during pregnancy.

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