In dogs with chronic enteropathy (idiopathic inflammatory bowel disease) is budesonide more effective than prednisolone or prednisone in resolving clinical signs?
The literature search revealed one paper that was directly relevant to the PICO question outlined; this was a randomised double-blinded treatment control study (Dye et al., 2013). This study design method provides a high strength of evidence when assessing treatment efficacy due to the minimisation of bias. The study compared a population of dogs diagnosed with idiopathic inflammatory bowel disease (IBD) treated blindly with either budesonide or prednisone. Budesonide, a non-halogenated glucocorticoid, was developed to limit systemic side effects in human patients with IBD; whereas prednisone is a glucocorticoid prodrug metabolised by the liver to its active metabolite prednisolone, which results in systemic side effects when administered (Becker, 2013). The diagnostic procedures before entry into and upon completion of the trial, alongside treatment protocols, were standardised. Evaluations conducted throughout the study included weekly owner questionnaires regarding their dog’s clinical signs and attitude, alongside repeat physical examination by one of the study authors 3 weeks and 6 weeks after the initiation of treatment. Information gathered enabled the calculation of CIBDAI score both at enrolment and at 6 weeks, with clinical remission being defined as a 75% reduction in the pretreatment CIBDAI score. The study found that there was no significant difference (P = < .0001) in the effectiveness of budesonide compared to prednisone in improving the CIBDAI scores of the study population; both treatments had similar overall remission rates.