LACK OF ADRENAL-GLAND SUPPRESSION WITH BUDESONIDE ENEMA IN ACTIVE DISTAL ULCERATIVE-COLITIS - A PREDNISOLONE-CONTROLLED 8-WEEK STUDY

Objective: To compare the effect of two glucocorticosteroid enemas, bu desonide and prednisolone, on adrenal gland function in patients with active distal ulcerative colitis. Design: A randomized, controlled, in vestigator-blind study. Setting: A multicentre study among outpatients from three Danish gastroenterology departments participating in a Sca ndinavian multicentre study. Patients: The study included 26 patients with active distal ulcerative colitis, with a median disease duration of 6.5 years and a median duration of the current disease exacerbation of 26 days. Intervention: Bedtime retention enemas, budesonide (2 mg/ 100 ml), or prednisolone disodium phosphate (25 mg/100 ml) were admini stered daily for up to 8 weeks. Adrenocorticotropic hormone (ACTH) tes ts were performed at entry and after 4 and 8 weeks of treatment. Resul ts: Baseline plasma cortisol values were significantly suppressed afte r 4 and 8 weeks of prednisolone treatment, but remained unchanged duri ng budesonide treatment. In the prednisolone group at weeks 4 and 8, p lasma cortisol levels were below 500 nmol/l 30 min after ACTH injectio n in eight out of 14 and four out of nine patients, respectively. By c ontrast, the ACTH tests were normal in the budesonide-treated patients . Conclusion: Budesonide enema is as effective as prednisolone enema i n the treatment of active distal ulcerative colitis and does not suppr ess adrenal gland function.