Corticosteroid therapy systemic preparations

Vaccinations containing live organisms are not administered within 3 months of immune globulin administration because antibodies in the globulin preparation may interfere with the immune response to the vaccination. Corticosteroids, antineoplastic dru, and radiation therapy depress the immune system to such a degree that insufficient numbers of antibodies are produced to prevent the disease. When the salicylates are administered with the varicella vaccination, there is an increased risk of Reye s syndrome developing. 

High-potency preparations are used primarily as alternatives to systemic corticosteroids when local therapy is feasible. 

In more severe disease corticosteroids are needed to induce remission (prednisolone 60 mg/day until remission induced, tailing the dose by 5 mg/week). Approximately 75% of patients respond. Budesonide, a potent topically active corticosteroid, is an alternative which can be administered either orally or as an enema. The oral preparation is presented as a delayed release formulation which delivers drug to the terminal ileum and ascending colon. Extensive first pass metabolism in the liver limits its systemic availability and potential for adverse effects. Budesonide is also useful as maintenance therapy of the 30% of patients with Crohn s disease who are steroid dependent. 

Traditional medical therapies for Crohn s disease include sulfasalazine and corticosteroids. These are pluripotent, reducing the production of inflammatory mediators and cytokines, although the complex and multiple mechanisms remain incompletely understood. Novel therapies related to newer aminosalicylate preparations such as balsalazide (colazide) or olsalazine (dipentum) newer corticosteroids such as budesonide immunomodulators such as azathioprine, 6-mercaptopurine, or methotrexate and antibiotics such as metronidazole are aimed at more specific delivery of active compounds to the site of disease, reduction of systemic absorption and side effects, and modulation of more focal targets within the immune response and the action of specific proinflammatory cytokines. 

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