Prednisolone metasulphobenzoate foam retention enemas suppress the hypothalamo-pituitary-adrenal axis.
BACKGROUND
Corticosteroid enemas represent effective treatment for ulcerative proctitis, but absorption into the systemic circulation may have undesirable metabolic consequences. Prednisolone metasulphobenzoate, a lipophobic corticosteroid derivative, is designed to be absorbed poorly through the recto-sigmoid mucosa, but the effects of foam enema preparations upon the hypothalamo-pituitary-adrenal axis have not been examined.


METHODS
Nine patients suffering from active ulcerative proctitis underwent four weeks of therapy with prednisolone metasulphobenzoate foam enemas. The hypothalamo-pituitary-adrenal axis, defined using the modified single-dose metyrapone test, glucose homeostasis and lipid profiles were studied before and after treatment.


RESULTS
The hypothalamo-pituitary-adrenal axis was significantly depressed after the treatment period; mean stimulated plasma cortisol concentration fell from 384 +/- 244 (s.d.) to 288 +/- 252 nmol/L, P < 0.02; stimulated mean plasma 11-deoxycortisol concentration fell from 677 +/- 333 to 407 +/- 326 nmol/L, P < 0.01. Mean fasting plasma glucose, insulin, C-peptide, fructosamine and triglyceride concentration were unchanged, whilst the mean serum cholesterol concentrations rose from 5.6 +/- 1.1 to 6.0 +/- 1.2 mmol/L (not significant).


CONCLUSIONS
Prednisolone metasulphobenzoate foam enemas have significant systemic and endocrine metabolic effects, which could assume importance with long-term therapy.
Gastrointestinal Unit, Western General Hospital, Edinburgh, UK.
W
W
Luman
R S
RS
Gray
R
R
Pendek
K R
KR
Palmer
D000285:Administration, Rectal; D000328:Adult; D000368:Aged; D001786:Blood Glucose; D003350:Cortodoxone / Q000097:blood; D004733:Enema; D005260:Female; D006706:Homeostasis / Q000187:drug effects; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000187:drug effects*; D007328:Insulin / Q000097:blood; D007408:Intestinal Absorption; D008297:Male; D008875:Middle Aged; D010913:Pituitary-Adrenal System / Q000187:drug effects*; D011239:Prednisolone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D011349:Proctitis / Q000188:drug therapy*; D011725:Pyridines / Q000494:pharmacology; D011863:Radioimmunoassay; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D007328:Insulin; D011725:Pyridines; D014280:Triglycerides; C013109:metapyrone; C013218:prednisolone 21-3-sulfobenzoate; D011239:Prednisolone; D003350:Cortodoxone; D006854:Hydrocortisone