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Systemic effects of oral budesonide in hematopoietic transplant: implications of drug interaction with azoles

Bone Marrow Transplantation volume 47, pages 1370–1371 (2012)Cite this article

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Gastrointestinal (GI) involvement in GvHD is common after allogeneic hematopoietic stem transplantation (alloHCT).1 Although 70–80% patients respond to systemic immunosuppressive therapy, additional therapy is required in patients with disabling GI symptoms. Non-absorbable corticosteroids including budenoside (BUD) and beclomethasone have been successfully used to treat GI GvHD,2, 3, 4 and the benefits confirmed in phase III randomized trials.5, 6 Both these non-absorbed steroids are inactivated via cytochrome P450 isoenzymes, so that concomitant administration of azoles, which compete for p450 binding, increase the bioavailability even of ‘non-absorbed’ steroids.7 Iatrogenic Cushing's syndrome has been described following concomitant administration of P450 inhibitors and inhaled budesonide in patients with HIV or cystic fibrosis,8, 9 but the clinical significance of this drug interaction after hematopoietic SCT remains unknown.

The development of iatrogenic Cushing's syndrome in one of our alloHCT patient who received BUD as the sole source of steroids, which led us to explore the frequency of Cushing's syndrome, or other manifestations of significant systemic exposure to exogenous steroids in patients who had received alloHCT and were receiving both BUD and an azole drug.

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Authors and Affiliations

  1. Department of Hematology–Oncology, Baylor College of Medicine, Houston, TX, USA

    R El Fakih

  2. Center for Cell and Gene Therapy, Baylor College of Medicine and The Methodist Hospital, Houston, TX, USA

    G A Obi, A Scholoff, G Carrum & R T Kamble

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  1. R El Fakih
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  2. G A Obi
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  3. A Scholoff
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  4. G Carrum
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  5. R T Kamble
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Correspondence to R T Kamble.

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El Fakih, R., Obi, G., Scholoff, A. et al. Systemic effects of oral budesonide in hematopoietic transplant: implications of drug interaction with azoles. Bone Marrow Transplant 47, 1370–1371 (2012). https://doi.org/10.1038/bmt.2012.17

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