Efficacy and tolerance of mesalazine suppositories vs. hydrocortisone foam in proctitis

Background: Topical treatments with steroids or mesalazine are the most effective treatments for idiopathic proctitis. Aim: to compare the efficacy and tolerance of mesalazine suppositories vs. hydrocortisone acetate foam in the treatment of acute proctitis. Patients and methods: 242 patients with active idiopathic proctitis were randomized to receive once daily either one Pentasa suppository (mesalazine 1 g) or 100 mg hydrocortisone (Colofoam) for 14–21 days (until remission). Disease activity and tolerance of the treatments were assessed using a daily questionnaire, by physician assessment, and endoscopy score. Results: Both treatments induced a significant reduction in disease activity. Mesalazine suppositories were significantly more effective than hydrocortisone on rectal blood loss (P=0.002) and mucus (P=0.02) parameters, and on the degree of the decrease in endoscopy score (P=0.02). No significant difference was observed between treatments concerning histology or tolerance. Conclusion: Mesalazine suppositories were as well-tolerated as hydrocortisone foam, but were more effective for some parameters of disease activity.