Controlled Trial of Sulphasalazine in the Treatment of Ulcerative Colitis.

EDITORIAL SYNOPSIS This paper provides further evidence that sulphasalazine is an effective agent in the treatment of mild or moderate colitis. There was a high incidence of gastrointestinal side-effects and one patient developed haemolytic anaemia. Sulphasalazine (salicylazosulphapyridine, Salazo-pyrin, Asulfidine) was first used by Svartz (1942) in the treatment of rheumatoid arthritis. Later, patients with arthritis associated with ulcerative colitis were treated with sulphasalazine with clinical improvement of both conditions (Svartz, 1948). The drug has since been used extensively in Scandinavia and in America in the treatment of ulcerative colitis, and many reports have indicated favourable results, some three-quarters of the patients showing Avery Jones (1960) report the result of two consecutive trials. In the first prednisone was compared with an inert tablet and found to be effective in cases of left-sided colitis. Prednisone was then used as a standard with which to compare sulphasalazine and hydrocortisone hemisuccinate retention enemata. There was no doubt about the effectiveness of prednisone as compared with that of an inert tablet. The authors considered that sulphasalazine probably brought about remission almost as frequently as prednisone, although more slowly. Under the conditions of their trial, however, a statistically significant result for the effectiveness of sulphasalazine was not obtained. The dosage of sulphasalazine used was 4 g. daily and the patients were assessed at the end of a three-week period. Truelove, Watkinson, and Draper (1962) compared combined oral and topical corticosteroid therapy with sulphasalazine over a 14-day period using the sequential method of analysis. The combined 'At present at King's College Hospital, London. corticosteroid therapy, given as a dose of prednisone, 20 mg. a day, and hydrocortisone hemisuccinate 100 mg. by retention enema, was shown to be significantly more effective in the 14-day period of the trial than sulphasalazine. The latter was given in a dose of 8 g. a day for the first week and 4 g. a day for the second. At the end of the two-week period 78 % of the patients on combined corti-costeroids had shown sigmoidoscopic improvement as opposed to 43 % on sulphasalazine. As emphasized by the authors, their trial shows only that combined corticosteroid treatment is better than sulphasalazine for rapidly checking an attack of the disease. The only formal double-blind trial comparing sulphasalazine with a placebo, which has been reported, was carried out by Baron, Connell, Lennard-Jones, and Avery Jones (1962). They tested in addition a new drug, salicylazosulphadimi-dine, …