Department of Gastroenterology, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
Pharmacy Department, Addenbrooke's Hospital, Cambridge University Hospitals, Cambridge, UK.
Dig Dis Sci. 2018 Apr;63(4):1011-1015. doi: 10.1007/s10620-017-4890-6. Epub 2018 Feb 19.
Management of proctitis refractory to conventional therapies presents a common clinical problem. The use of acetarsol suppositories, which are derived from organic arsenic, was first described in 1965. Data concerning clinical efficacy and tolerability are very limited.
To examine the efficacy of acetarsol suppositories for the treatment of refractory proctitis.
A retrospective analysis was performed on patients with inflammatory bowel disease treated with acetarsol suppositories between 2008 and 2014 at Addenbrooke's Hospital, Cambridge, United Kingdom. Clinical response was defined as resolution of symptoms back to baseline at the time of next clinic review.
Thirty-nine patients were prescribed acetarsol suppositories between March 2008 and July 2014 (29 patients with ulcerative colitis, nine with Crohn's disease, and one with indeterminate colitis). Thirty-eight were included for analysis. The standard dose of acetarsol was 250 mg twice daily per rectum for 4 weeks. Clinical response was observed in 26 patients (68%). Of the 11 patients who had endoscopic assessment before and after treatment, nine (82%) showed endoscopic improvement and five (45%) were in complete remission (Wilcoxon signed-rank test p = 0.006). One patient developed a macular skin rash 1 week after commencing acetarsol, which resolved within 4 weeks of drug cessation.
Acetarsol was effective for two out of every three patients with refractory proctitis. This cohort had failed a broad range of topical and systemic treatments, including anti-TNFα therapy. Clinical efficacy was reflected in significant endoscopic improvement. Adverse effects of acetarsol were rare.
常规治疗无效的直肠炎是一个常见的临床问题。1965 年首次描述了使用源自有机砷的乙酰胂酸栓剂。关于临床疗效和耐受性的数据非常有限。
评估乙酰胂酸栓剂治疗难治性直肠炎的疗效。
对 2008 年至 2014 年间在英国剑桥阿登布鲁克医院接受乙酰胂酸栓剂治疗的炎症性肠病患者进行回顾性分析。临床缓解定义为下次就诊时症状缓解至基线水平。
39 例患者于 2008 年 3 月至 2014 年 7 月期间接受乙酰胂酸栓剂治疗（溃疡性结肠炎 29 例，克罗恩病 9 例，未定型结肠炎 1 例）。38 例纳入分析。乙酰胂酸栓剂的标准剂量为每天直肠内 2 次，每次 250mg，共 4 周。26 例（68%）观察到临床缓解。在治疗前后进行内镜评估的 11 例患者中，9 例（82%）内镜改善，5 例（45%）完全缓解（Wilcoxon 符号秩检验，p=0.006）。1 例患者在开始使用乙酰胂酸后 1 周出现斑丘疹，停药 4 周内消退。
乙酰胂酸对三分之二难治性直肠炎患者有效。该队列患者对包括抗 TNFα 治疗在内的广泛的局部和全身治疗均无效。临床疗效反映在显著的内镜改善上。乙酰胂酸的不良反应罕见。
