Treatment with corticosteroids and high-dose Pulmicort (budesonide) are both effective induction therapies for patients with mild-to-moderate Crohn’s disease, though high-dose Asacol (mesalamine) also offers an effective alternative with fewer side effects.

Those are among the findings of a study, “Comparative Effectiveness of Mesalamine, Sulfasalazine, Corticosteroids, and Budesonide for the Induction of Remission in Crohn’s Disease: A Bayesian Network Meta-analysis,” published in the journal Inflammatory Bowel Diseases.

Crohn’s is a type of inflammatory bowel disease (IBD) that may strike any part of the gastrointestinal tract. Symptoms often include abdominal pain, diarrhea, fever and weight loss. IBD affects between 26 and 199 per 100,000 Americans, according to the Centers for Disease Control and Prevention.

Corticosteroids are commonly prescribed to treat mild to moderately active Crohn’s, though patients with ileal and right-sided colonic disease are often prescribed Pulmicort (budesonide), an alternative corticosteroid with a reduced side-effect profile.

Guidelines from the American College of Gastroenterology suggest that Asacol (mesalamine) is barely effective for the treatment of mild-to-moderate Crohn’s. Many gastroenterologists continue to prescribe it for active Crohn’s, though it has recently fallen out of favor.

Gilaad G. Kaplan, MD, MPH, of Canada’s University of Calgary, analyzed 22 trials involving 2,968 patients that compared Pulmicort, Azulfidine (sulfasalazine), Asacol or corticosteroids with each other or placebo. The aim was to compare the number of Crohn’s patients who achieved induction of remission with these different therapeutic options. Pulmicort and Asacol were categorized into low and high doses.

The results showed that corticosteroids were the most effective therapy to induce clinical remission compared with placebo, followed by high-dose Pulmicort above 6 grams daily.

The researchers also found that high-dose Asacol (more than 2.4 grams per day) was superior to placebo for induction of remission in Crohn’s patients, offering an alternative therapy in patients with mildly active Crohn’s seeking to avoid steroids. While corticosteroids were comparably effective to high-dose Pulmicort, Azulfidine was not significantly more effective than other therapies or placebo in inducing clinical remission.

“Although budesonide and prednisone [Pulmicort] should be considered first-line recommendations, high-dose mesalamine [Asacol] can be offered to patients who prefer to avoid steroids,” researchers concluded. “Future head-to-head RCTs [randomized controlled trials] are necessary to clarify the role of mesalamine in the treatment of active mild-to-moderate Crohn’s disease.”