ULCERATIVE COLITIS: THERAPEUTIC EFFECTS OF CORTICOTROPIN (ACTH) AND CORTISONE IN 120 PATIENTS

Abstract

Corticotropin (ACTH) or cortisone was administered to 120 patients with moderately severe or severe ulcerative colitis. The immediate clinical response to corticotropin was good or favorable in 94 of 108 ACTH patients and in 9 of 12 cortisone patients. Fever, tachycardia, abdominal distress and bloody diarrhea promptly subsided; increased appetite and a pronounced sense of well-being developed. Usually the proctoscopic appearance of the bowel improved. Symptoms have recurred in 68 of 94 patients responding initially to ACTH and in 6 of 9 cortisone-treated patients improving immediately. Many of the recurrences appeared to be less severe than those preceding steroid therapy. Remissions have continued in 26 of 94 patients in the ACTH group and in 3 of 9 in the cortisone group responding immediately; 9 patients have remained well 2 and 3 years after treatment. Corticotropin gel, though less potent than the aqueous preparation, was occasionally effective. Corticotropin intravenously induced striking and, at times, dramatic improvement in 14 patients not responding adequately to ACTH intramuscularly. Compound F, administered orally in moderate amounts to 3 patients, appeared to be less effective than ACTH and more potent than cortisone. The current clinical status seems excellent in 35 cases and moderately improved in 57; 12 are unimproved but continue medical treatment; 9 patients required colectomy and ileostomy, with excellent to satisfactory results in 7. There were 7 deaths, 4 of causes unrelated to steroid therapy and 3 probably attributable to the use of corticotropin. Corticotropin (ACTH) and cortisone do not specifically cure ulcerative colitis, prevent recurrences or replace established methods of treatment; nevertheless, when administered in sufficient quantities and with due regard for the various complications of therapy and of the disease itself, the hormones are useful therapeutic adjuncts.