TREATMENT OF REFRACTORY DIARRHEA IN AIDS WITH ACETORPHAN AND OCTREOTIDE - A RANDOMIZED CROSSOVER STUDY

Objective: To compare the efficacy and tolerance of acetorphan, an ora lly active enkephalinase inhibitor whose antidiarrhoeal properties der ive from a purely antisecretory activity, to that of octreotide, a sub cutaneously administered somatostatin analogue, in the treatment of re fractory diarrhoea in AIDS patients. Design: An open randomized crosso ver trial. Setting: The inpatient medical units of three hospitals. Pa tients: Thirteen adult inpatients with AIDS and refractory diarrhoea t hat lasted for 35 +/- 8 weeks despite use of traditional antidiarrhoea l agents and was characterized by 7.0 +/- 1.2 stools/day, weighing 103 3 +/- 174 g/day with a lipid output of 18.8 +/- 3.5 g/day. Interventio ns: Acetorphan (100-300 mg thrice daily) and octreotide (50-150 mu g t hrice daily) were given in random order during two 1-week periods. Mai n outcome measures: Response was defined as a reduction by at least on e-third of both daily stool number and weight. Results: The mean daily stool number was reduced to 4.6 +/- 1.1 with acetorphan (P less than or equal to 0.05) but was 5.6 +/- 1.2 with octreotide (NS). Whereas tw o patients responded to both treatments, two responded to acetorphan a lone and one to octreotide alone. Daily lipid output in faeces was red uced non-significantly with acetorphan (11.5 +/- 2.3 g) but was nearly doubled with octreotide (33.7 +/- 12.0 g). Acetorphan was very well t olerated. Conclusion: Enkephalinase inhibitors may be a useful alterna tive to somatostatin analogues in the management of refractory diarrho ea in AIDS.