Mesalazine Suppositories versus Hydrocortisone Foam in Patients with Distal Ulcerative Colitis:A Comparison of the Efficacy and Practicality of Two Topical Treatment Regimens

Abstract

Background: Topical treatment is effective in patients with distal ulcerative colitis. This trial compares the efficacy, safety, and practicality of 4 weeks' treatment with 500 mg mesalazine suppositories with those of 178 mg hydrocortisone foam, both given twice daily. Methods: Seventy-nine patients with distal ulcerative colitis were stratified on the basis of the extent of the disease (proctitis and proctosigmoiditis) and randomized to one of the treatment groups. A disease activity index (DAI) based on symptoms and endoscopic findings was calculated. The patients evaluated the practicality of the treatment regimens, patient compliance was measured, and histologic findings recorded. Results: Of all the patients 22% and 38% were complete responders after 2 and 4 weeks, respectively. Median DAIs in the mesalazine and hydrocortisone groups before and after 2 and 4 weeks' treatment were 14, 6, and 4, and 13, 8, and 6, respectively. The difference between the treatment groups was statistically significant (p = 0.02) due to a better effect of mesalazine in patients with proctitis. Patients' evaluation of practicality and patient compliance were statistically significantly better in the mesalazine group. Conclusions: Both treatment regimens are effective; mesalazine suppositories seem to be the preferred alternative.

Key Words:

• Drug therapy
• enema
• foam
• hydrocortisone
• mesalazine
• proctitis
• proctosigmoiditis
• suppositories
• topical treatment
• ulcerative colitis