RECTAL CORTICOSTEROIDS VERSUS ALTERNATIVE TREATMENTS IN ULCERATIVE-COLITIS - A METAANALYSIS

Background-Clear strategies to optimise the use of corticosteroids in ulcerative colitis are lacking, Aim-A meta-analysis was undertaken to examine critically the role of rectal corticosteroids in the managemen t of active distal ulcerative colitis. Methods-All reported randomised controlled trials were retrieved by searching the Medline and EMBASE databases and the bibliographies of relevant studies. Trials which met inclusion criteria were assessed for scientific rigour. Data were ext racted by two independent observers according to predetermined criteri a. Results-Of 83 trials retrieved, 33 met inclusion criteria. Pooled o dds ratios (FOR) showed conventional rectal corticosteroids and rectal budesonide to be clearly superior to placebo. In seven trials, rectal 5-aminosalicylic acid (5-ASA) was significantly better than conventio nal rectal corticosteroids for inducing remission of symptoms, endosco py, and histology with POR of 2.42 (95% confidence interval (CI) 1.72- 3.41), 1.89 (95% CI 1.29-2.76), and 2.03 (95% CI 1.28-3.20), Methods r espectively. Rectal budesonide was of Relevant comparable efficacy to conventional corticosteroids but produced less endogenous cortisol sup pression. Side effects, although inconsistently reported, were general ly minor. A cost comparison of rectal preparations showed 5-ASA to be less expensive than corticosteroids. Conclusions-Rectal 5-ASA is super ior to rectal corticosteroids in the management of distal ulcerative c olitis.