A controlled comparison of corticotropin and hydrocortisone in the treatment of severe proctocolitis.

A randomized controlled trial has been made of corticotropin (ACTH) 80 units given intramuscularly daily and hydrocortisone 400 mg infused intravenously over 24 hours, in the treatment of in-patients with severe proctocolitis. Seven patients were treated with ACTH and nine with hydrocortisone over an initial seven days. Three patients in the ACTH group and six in the hydrocortisone group improved and were discharged on medical treatment. Four patients treated with ACTH and two with hydrocortisone required urgent colectomy during this admission. Plasma cortisol levels were measured, but there was no correlation between these and the observed therapeutic response. Sideeffects were troublesome in both groups but were more marked in those treated with hydrocortisone. It is concluded that ACTH is not intrinsically superior to hydrocortisone in these doses, in the treatment of severe proctocolitis.