Patients with chronic ulcerative colitis (UC) have a less-than-ideal choice: long-term steroid therapy or immunosuppressant drugs. But a new option might give them a better chance. The treatment is based on the concept of UC being caused by a dysfunction in the mucosal barrier in the colon, which in turn results from a lack of mucoprotective phos-phatidylcholine.
In a study at University Hospital in Heidelberg, Germany, 60 patients with chronic steroid-refractory UC and high clinical and endoscopic disease activity scores were assigned to receive phosphatidylcholine or cellulose placebo four times daily for 12 weeks.
Half of the treatment group and three placebo patients achieved the endpoints: complete steroid withdrawal and reduced clinical activity index scores, or improved scores of 50% or more.
The only relevant adverse effect was mild bloating. By contrast, as noted by the researchers, 10% to 50% of patients taking immunosuppressant drugs have adverse events, which can be serious. In addition to having a better safety profile, phosphatidylcholine seems to work for approximately one to two months earlier than azathioprinу drags or 6-mercaptopurine.
Clinical improvements with phosphatidylcholine were also correlated with changes in quality of life. Thirteen patients in the treatment group, compared with five in the placebo group, achieved remission. Nineteen treated patients and six placebo patients showed improvements of 25% or more in Inflammatory Bowel Disease Questionnaire scores.
(Source: Ann Intern Med 2007;147: 603-610.)