Long-term steroid treatment is discouraged in ulcerative colitis.
Alternatives are lacking when therapy with immunosuppressant drugs fails.
An insufficient level of phosphatidylcholine in colonic mucus is a possible pathogenetic factor for ulcerative colitis.
|80% of phosphatidylcholine recipients discontinued steroid therapy |
|Annals of Internal Medicine|
Dr Wolfgang Stremmel and colleagues from Germany assessed whether steroid withdrawal is easier with retarded-release phosphatidylcholine vs placebo in adults with chronic steroid-refractory ulcerative colitis.
The team of doctors conducted a randomized, double-blind, placebo-controlled trial from 2003 to 2006 at a referral center for inflammatory bowel disease based at a university teaching hospital.
The team identified 60 patients with chronic steroid-refractory ulcerative colitis, and high clinical and endoscopic disease activity indexes (score 5).
Phosphatidylcholine or cellulose placebo was ingested 4 times daily for 12 weeks for a total dosage of 2 g/d.
The follow-up rate was 97%.
The doctors found that the number of patients achieving complete steroid withdrawal and either a low or improved clinical activity index was 50% or more.
The team noted that the primary end point was achieved in 50% of phosphatidylcholine recipients vs 10% of placebo recipients.
The doctors observed that 80% of phosphatidylcholine recipients and 10% of placebo recipients discontinued steroid therapy without disease exacerbation.
The team of doctors found that mild bloating was a common adverse event.
The team reported that the sample size was small, and the study was of short duration.
Dr Stremmel's team concluded, "Phosphatidylcholine reduced corticosteroid dependence more than placebo in patients with chronic steroid-refractory ulcerative colitis."
"The next step is long-term trials to evaluate the sustainability of steroid withdrawal in these patients."