Budesonide versus systemic corticosteroids in IgA Nephropathy: A retrospective, propensity-matched comparison.

IgA Nephropathy (IgAN) is characterized by mesangial deposition of dominant, polymeric, galactose-deficient IgA1 molecules of gut-associated lymphoid tissue origin. We sought to evaluate the efficacy of targeting the mucosal immune system dysregulation underlying IgAN pathogenesis with a pH-modified formulation of budesonide with a maximum release of active compound in the distal ileum and proximal colon.We did a retrospective study evaluating the efficacy of budesonide (Budenofalk) in the treatment of IgAN. From a retrospective cohort of 143 patients with IgAN followed in our department we identified 21 patients that received treatment with budesonide. These patients received budesonide at a dose of 9 mg/d in the first 12 months, followed by a dose reduction to 3 mg/d for the subsequent period. Only patients that received a 24-month treatment with budesonide were included in the analysis (n = 18). We matched the budesonide-treated cohort to 18 patients with IgAN treated with systemic steroids from the same retrospective cohort. Efficacy was measured as change in proteinuria, hematuria and estimated glomerular filtration rate over a 24-month period.Treatment with budesonide was associated with a 24-month renal function decline of -0.22 (95%CI, -8.2 to 7.8) ml/min/1.73m, compared to -5.89 (95%CI, -12.2 to 0.4) ml/min/1.73m in the corticosteroid treatment group (p = 0.44, for between group difference). The median reduction in proteinuria at 24-month was 45% (interquartile range [IQR]: -79%; -22%) in the budesonide group and 11% (IQR: -39%; 43%) in the corticosteroid group, respectively (P = .009, for between group difference). The median reduction in hematuria at 24-month was 72% (IQR: -90%; -45%) in the budesonide group and 73% (IQR: -85%; 18%) in the corticosteroid group, respectively (P = .22, for between group difference). Treatment with budesonide was well tolerated with minimal side effects.Budesonide (Budenofalk) was effective in the treatment of patients with IgAN at high-risk of progression in terms of reducing proteinuria, hematuria and preserving renal function over 24 months of therapy.

El impacto de los nuevos corticosteroides tópicos en el tratamiento de la dermatitis atópica / The impact of new topical corticosteroids on the management of atopic dermatitis

La dermatitis atópica es una frecuente enfermedad inflamatoria cutánea de los niños. Aunque las formas graves requieren terapias agresivas (corticosteroides sistémicos, ciclosporina), en la mayoría de los casos el uso de los corticoides tópicos pueden resultar satisfactorio. En los últimos 10 años han aparecido nuevos preparados de uso tópico eficaces y seguros. Las características comunes a todos ellos son su potencia alta tipo clase III y la escasez de efectos secundarios. Entre ellos se encuentran la budesonida, prednicarbato, metilprednisolona aceponato, furoato de mometasona y propionato de fluticasona. Los pacientes afectados por dermatitis atópica tienen un alto riesgo de desarrollar una sensibilización a los corticoides. Éste es uno de los efectos secundarios más importantes causados por los nuevos corticoides, en particular la budesonida (AU)