Systemic and local corticosteroid therapy in ulcerative colitis

Abstract

A comparative study of different types of corticosteroid therapy has been made to determine their relative efficacy in bringing about a rapid clinical remission in ulcerative colitis of mild or moderate severity. A rapid clinical remission is defined as complete loss of symptoms within two weeks of starting treatment and with decisive improvement in the sigmoidoscopic appearances. Patients were allotted at random to one or other of three treatments (1) Prednisolone by mouth in a dose of 5 mg. q.d.s. (2) Local treatment with a water-soluble corticosteroid applied by means of a nightly rectal drip. Two different corticosteroids were used—namely, hydrocortisone hemisuccinate sodium and prednisolone 21-phosphate. (3) Combined systemic and local treatment, in which the patients received oral prednisolone in a dose of 5 mg. q.d.s. and a nightly rectal drip of either hydrocortisone hemisuccinate sodium or prednisolone 21-phosphate. The results obtained in 120 courses of treatment are presented, there being 40 patients in each of the three main treatment groups. About one-third of the patients treated with oral prednisolone went into rapid clinical remission. With local corticosteroid treatment nearly three-quarters of the patients had a rapid clinical remission. There is little to choose between the two corticosteroids used for local treatment, each of them being much more effective than oral prednisolone in the dose used. With combined systemic and local treatment the results depended upon the particular combination used. When oral prednisolone was combined with local prednisolone 21-phosphate the results were similar to those of local treatment used alone. When oral prednisolone was combined with local hydrocortisone hemisuccinate sodium all the patients so treated showed rapid remission. This second combination therefore emerges as the best of the various treatments studied. Some practical and theoretical implications of the present results are discussed. © 1960, British Medical Journal Publishing Group. All rights reserved.