Are there differences in type, dosage, and method of administration for the systemic steroids in IBD treatment?

Systemic corticosteroids are available in parenteral hydrocortisone and methylprednisolone formulations and oral prednisone, prednisolone, and budesonide formulations.1 Hydrocortisone is the biologically active liver metabolite of cortisol. Methylprednisolone, prednisolone, and prednisone are synthetic analogs of cortisol. Prednisone is metabolized by the liver to the active moiety prednisolone.2 While effective, all have systemic side effects. In an attempt to limit this toxicity, rapidly metabolized corticosteroids were introduced. Budesonide has a potent topical activity (15 times greater affinity for the glucocorticoid receptor than prednisolone), but a reduced systemic distribution due to a 90% first-pass liver metabolism.3 Budesonide's coated capsules slowly release it into the distal ileum and proximal colon.4 For distal colonic disease, topical enema and foam preparations are available. Although these topical corticosteroid treatments are not considered “systemic,” they have systemic distribution and toxicity potential.5 Oral corticosteroids effectively induce remission of moderate ulcerative colitis (UC), regardless of disease location.6 They are also effective for mild to moderate UC that has not responded to mesalamine preparations. Standard therapy is either prednisone 40–60 mg daily or prednisolone 1 mg/kg/day, followed by a slow tapering off over 12–16 weeks are equally effective.