title: Treatment of refractory diarrhoea in AIDS with acetorphan and octreotide: a randomized crossover study.
abstract: OBJECTIVE
  To compare the efficacy and tolerance of acetorphan, an orally active enkephalinase inhibitor whose antidiarrhoeal properties derive from a purely antisecretory activity, to that of octreotide, a subcutaneously administered somatostatin analogue, in the treatment of refractory diarrhoea in AIDS patients.
  
  
  METHODS
  An open randomized crossover trial.
  
  
  METHODS
  The inpatient medical units of three hospitals.
  
  
  METHODS
  Thirteen adult inpatients with AIDS and refractory diarrhoea that lasted for 35 +/- 8 weeks despite use of traditional antidiarrhoeal agents and was characterized by 7.0 +/- 1.2 stools/day, weighing 1033 +/- 174 g/day with a lipid output of 18.8 +/- 3.5 g/day.
  
  
  METHODS
  Acetorphan (100-300 mg thrice daily) and octreotide (50-150 micrograms thrice daily) were given in random order during two 1-week periods.
  
  
  METHODS
  Response was defined as a reduction by at least one-third of both daily stool number and weight.
  
  
  RESULTS
  The mean daily stool number was reduced to 4.6 +/- 1.1 with acetorphan (P < or = 0.05) but was 5.6 +/- 1.2 with octreotide (NS). Whereas two patients responded to both treatments, two responded to acetorphan alone and one to octreotide alone. Daily lipid output in faeces was reduced non-significantly with acetorphan (11.5 +/- 2.3 g) but was nearly doubled with octreotide (33.7 +/- 12.0 g). Acetorphan was very well tolerated.
  
  
  CONCLUSIONS
  Enkephalinase inhibitors may be a useful alternative to somatostatin analogues in the management of refractory diarrhoea in AIDS.
authors.affiliation: Hôpital Rothschild, Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Beaugerie
authors.forename: P
authors.initials: P
authors.lastname: Baumer
authors.forename: S
authors.initials: S
authors.lastname: Chaussade
authors.forename: H
authors.initials: H
authors.lastname: Berard
authors.forename: W
authors.initials: W
authors.lastname: Rozenbaum
authors.forename: G
authors.initials: G
authors.lastname: Pialoux
authors.forename: Y
authors.initials: Y
authors.lastname: Le Quintrec
authors.forename: J C
authors.initials: JC
authors.lastname: Schwartz
authors.forename: J M
authors.initials: JM
authors.lastname: Lecomte
mesh_terms: D000328:Adult; D000930:Antidiarrheals / Q000627:therapeutic use*; D018592:Cross-Over Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D019053:HIV Enteropathy / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D011480:Protease Inhibitors / Q000627:therapeutic use*; D015244:Thiorphan / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000930:Antidiarrheals; D005765:Gastrointestinal Agents; D011480:Protease Inhibitors; C049331:racecadotril; D015244:Thiorphan; D015282:Octreotide