High Budesonide Bioavailability In Patients With Gastro-Intestinal (GI) Graft Versus Host Disease (GVHD) AND/OR Clostridium Difficile Infection

Abstract

Background: Therapy of acute intestinal GVHD is routinely treated with immunosuppressive agents, including systemic corticosteroids. Several reports have shown responses of using “topical” therapy with budesonide for GI GVHD. Budesonide is a potent steroid with low oral bioavailability due to high first pass metabolism by CYP 3A4. In patients with Crohn's disease, bioavailability is approximately 10–20%. No data are available in hematopoeitic stem cell transplant recipients. Several reports using budesonide for the treatment of GI GVHD have noted responses in other GVHD sites, thus questioning if active absorption was occurring.