TNF and infection: Corticosteroids decrease levels of inflammatory cytokines such as interleukin (IL)-1, IL-6, and tumor necrosis factor (TNF)-α through inhibition of protein synthesis and transcription.[7] Unfortunately, systemic corticosteroids are associated with numerous cosmetic and serious adverse events including cushingoid features infection, hypertension, osteoporosis, and diabetes mellitus.[8] Budesonide is a glucocorticoid with extensive first-pass hepatic metabolism by cytochrome P-450 enzymes.