The use of ACTH, cortisone, hydrocortisone and related compounds in the management of ulcerative colitis

Experience in 180 patients
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      Since January, 1950, 180 patients with ulcerative colitis have been treated with ACTH, cortisone, hydrocortisone and the newer analogues. In most instances these agents were prescribed as adjuncts to a comprehensive medical program. The disease was classified clinically as severe or moderately severe in 92 per cent of the patients. Steroid therapy was initiated with corticotropin in 134 patients, with hydrocortisone in twenty-nine cases and in the remaining seventeen with either cortisone, prednisone or prednisolone.
      An immediate beneficial effect was observed in 85 per cent of the patients. The response to corticotropin was more dramatic and more uniform than to the other agents; the beneficial effects included subsidence of fever, tachycardia, abdominal distress, and blood in the feces, together with increase in appetite and a pronounced sense of well being. The bowel movements decreased in frequency and the discharges improved in consistency, although somewhat more slowly. Proctoscopic improvement occurred in the majority of patients but less rapidly than the clinical response.
      Symptoms recurred in 70 per cent of the patients. The recurrence rate in those with a relatively brief history was lower than the overall figure. Repeated courses of corticotherapy induced favorable responses in the majority of ninety-one patients. However, the results were not as striking as in the first course. At present, 113 patients are considered to be in complete or partial remission; forty-four continue on steroid therapy. Thirty-nine patients have been in remission since the first course; the remainder have received multiple courses. Thirty-five patients are unimproved. Seventeen patients have undergone surgery, twelve have died (including one of the surgical group), and four have been lost to follow-up.
      The most common side effects were Cushinglike changes in 137 patients, alkalosis in ninety-five, hypokalemia in forty-five and hyperglycemia or glycosuria in twenty-six; these untoward effects seldom were severe enough to discontinue therapy. The more serious but less frequent complications included temporary psychosis in ten, two suicides, allergy to ACTH in nine, and severe infections in five. Peptic ulcer developed in only one patient; nine individuals with peptic ulcer received large doses of steroids without untoward effects.
      ACTH produced more frequent and the most profound side effects but, in general, was the most effective compound. Hydrocortisone, prednisone and prednisolone were less effective but often produced comparable clinical results with fewer side effects. Cortisone did not compare favorably with the other corticoids.
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