The course of Crohn’s disease is characterised by frequent flares and periods of remission. Apart from the physical suffering, patients experience many psychosocial drawbacks due to active disease, resulting in lower quality of life. Therefore it is very important to control active disease quickly, efficiently and with few side effects. The trial reported recently by Thomsen et alclearly shows that the topically acting glucocorticosteroid (GCS) budesonide, administered as a controlled ileal release formulation, is significantly better at inducing remission than high dose mesalamine.

The benefit is important clinically as at each time point remission rates were about 50% higher for budesonide and at 12 weeks almost twice as many patients achieved remission on budesonide (62%) compared with mesalamine (36%; p<0.001). The median time to remission was also shorter in the budesonide group than in the mesalamine group (28v 84 days, p=0.04).

The remission rates obtained with budesonide are remarkably similar in all studies on the controlled ileal release capsule (CIR-Entocort). They range between 52 and 69% at eight weeks. The efficacy of this regimen is slightly inferior to 40 mg prednisolone but the incidence of side effects, especially cosmetic ones like acne and moon face, is …