Literature Review: CORE I & II: COlonic RElease Budesonide for the Induction of Remission for Mild- Moderate Ulcerative Colitis

Budesonide is a second generation corticosteroid with very high affinity for the cortisol receptor, and active first pass hepatic metabolism through the cytochrome p450-3CA4 pathway.1,2 With a 90% first pass hepatic metabolism of budesonide, systemic corticosteroid side effects are minimized, while targeted end organ release can maximize corticosteroid benefit.1,2 The use of targeted release forms of budesonide for allergic disorders of the nasopharynx, esophagus, and respiratory tract are now considered standard of care over oral corticosteroids.2,3,4,5 Budesonide MMX (multi-matrix system, Cosmo Pharmaceuticals SpA, Lainte, Italy) utilizes a unique pH dependent drug release process to deliver and release budesonide throughout the colon, see Figure 1.6 This pharmacology theoretically maximizes drug delivery to the colon and minimizes systemic corticosteroid side effects.6