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Spennacchio A, Lopalco A, Racaniello GF, Cutrignelli A, la Forgia FM, Fontana S, Cristofori F, Francavilla R, Lopedota AA, Denora N. Mucoadhesive Budesonide Solution for the Treatment of Pediatric Eosinophilic Esophagitis. Pharmaceuticals (Basel) 2024; 17:550. [PMID: 38794121 PMCID: PMC11124118 DOI: 10.3390/ph17050550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/13/2024] [Accepted: 04/21/2024] [Indexed: 05/26/2024] Open
Abstract
Eosinophilic Esophagitis is an antigen-mediated inflammatory disease characterized by thickening of the esophageal wall, leading to dysphagia, vomiting, reflux, and abdominal pain. This disease can be treated with a therapeutic approach ranging from diet to pharmacological therapy. Jorveza® (budesonide) and Dupixent® (dupilumab) are treatments for Eosinophilic Esophagitis approved by the European Medicines Agency in adults but not in children. Budesonide-based extemporaneous oral liquid suspensions could be prepared for pediatric use. The main limit of this formulation is that budesonide needs a longer residence time on the esophageal mucosa to solubilize and diffuse in it to exert its local anti-inflammatory effect. Herein, we propose the development of an extemporaneous mucoadhesive oral budesonide solution for the pediatric population. A liquid vehicle containing hydroxypropyl-beta-cyclodextrin as a complexing agent and carboxymethylcellulose sodium as a mucoadhesive excipient was used to prepare budesonide-based formulations. A stable solution at a concentration of 0.7 mg/mL was successfully prepared and characterized. The formulation showed rheological and mucoadhesive properties suitable for an Eosinophilic Esophagitis local prolonged treatment. In this way, pharmacists can prepare stable budesonide-based mucoadhesive solutions, providing both patients and physicians with a new therapeutic option for Eosinophilic Esophagitis pediatric treatment.
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Affiliation(s)
- Antonio Spennacchio
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, 70125 Bari, Italy; (A.S.); (A.L.); (G.F.R.); (A.C.); (A.A.L.)
| | - Antonio Lopalco
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, 70125 Bari, Italy; (A.S.); (A.L.); (G.F.R.); (A.C.); (A.A.L.)
| | - Giuseppe Francesco Racaniello
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, 70125 Bari, Italy; (A.S.); (A.L.); (G.F.R.); (A.C.); (A.A.L.)
| | - Annalisa Cutrignelli
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, 70125 Bari, Italy; (A.S.); (A.L.); (G.F.R.); (A.C.); (A.A.L.)
| | - Flavia Maria la Forgia
- Centro Studi e Ricerche “Dr. S. Fontana 1900–1982”, Farmalabor s.r.l., 76012 Canosa di Puglia, Italy; (F.M.l.F.); (S.F.)
| | - Sergio Fontana
- Centro Studi e Ricerche “Dr. S. Fontana 1900–1982”, Farmalabor s.r.l., 76012 Canosa di Puglia, Italy; (F.M.l.F.); (S.F.)
| | - Fernanda Cristofori
- Interdisciplinary Department of Medicine, Paediatric Section, University of Bari Aldo Moro, Paediatric Hospital Giovanni XXIII, 70125 Bari, Italy; (F.C.); (R.F.)
| | - Ruggiero Francavilla
- Interdisciplinary Department of Medicine, Paediatric Section, University of Bari Aldo Moro, Paediatric Hospital Giovanni XXIII, 70125 Bari, Italy; (F.C.); (R.F.)
| | - Angela Assunta Lopedota
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, 70125 Bari, Italy; (A.S.); (A.L.); (G.F.R.); (A.C.); (A.A.L.)
| | - Nunzio Denora
- Department of Pharmacy-Pharmaceutical Sciences, University of Bari Aldo Moro, 70125 Bari, Italy; (A.S.); (A.L.); (G.F.R.); (A.C.); (A.A.L.)
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Olivas I, Cobreros M, Londoño MC, Díaz-González Á. Budesonide in the first line treatment of patients with autoimmune hepatitis. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:561-570. [PMID: 34923033 DOI: 10.1016/j.gastrohep.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/12/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
Budesonide is a glucocorticoid characterized by its local action, with a low systemic bioavailability. Since the original trial comparing budesonide with prednisone in 2010, it is recommended as an effective alternative for the treatment of non-severe acute or chronic autoimmune hepatitis. In this document, we review the general pharmacologic properties of glucocorticoids, the available evidence for the use of budesonide as first line option for autoimmune hepatitis as well as the safety profile of the drug.
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Affiliation(s)
- Ignasi Olivas
- Liver Unit. Hospital Clínic of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). CIBERehd. Universitat de Barcelona, Barcelona, Spain
| | - Marina Cobreros
- Digestive Diseases Department. Marqués de Valdecilla University Hospital. Instituto de investigación sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - María-Carlota Londoño
- Liver Unit. Hospital Clínic of Barcelona. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). CIBERehd. Universitat de Barcelona, Barcelona, Spain
| | - Álvaro Díaz-González
- Digestive Diseases Department. Marqués de Valdecilla University Hospital. Instituto de investigación sanitaria Valdecilla (IDIVAL), Santander, Spain
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Evidence of Systemic Absorption of Enteral Budesonide in Patients with Fontan-Associated Protein-Losing Enteropathy. Pediatr Cardiol 2020; 41:241-250. [PMID: 31707491 DOI: 10.1007/s00246-019-02248-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/31/2019] [Indexed: 12/25/2022]
Abstract
To evaluate for evidence of systemic glucocorticoid absorption in cases of Fontan-associated protein-losing enteropathy (PLE) treated with enteral budesonide, we reviewed the charts of 27 patients with Fontan-associated PLE followed at Children's Hospital Colorado from 2005 to 2018. Cases were excluded for lack of budesonide thserapy or a treatment duration of less than 6 months. Charts were examined by two endocrinologists for review of prior biochemical endocrine evaluations, alterations in linear growth, and physical exam findings consistent with steroid excess. Twelve patients met inclusion criteria. Eight had prior documented cortisol screening. Three patients were tested while on treatment with a median fasting AM cortisol of 0.9 mcg/dL; two of these had a concomitantly measured ACTH, both below the detectable limit. Five patients were tested while weaning or having discontinued budesonide, with a median fasting AM cortisol of 9.1 mcg/dL. Eleven patients had decreases in height velocity associated with starting budesonide. Six patients had documentation of cushingoid features by an endocrinologist. In this cohort of children treated with budesonide for PLE following Fontan, clinical signs of systemic glucocorticoid absorption were frequent. Cortisol secretion was suppressed while on therapy, with adrenal recovery noted once budesonide was discontinued. Growth failure and cushingoid features were common findings. While these findings should be confirmed in larger cohorts, we recommend that the evaluation for systemic absorption of exogenous steroids be considered in patients treated with long-term enteral budesonide given the potential risk for adrenal crisis in times of physiologic stressors.
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