Acetarsol Suppositories: Effective Treatment for Refractory Proctitis in a Cohort of Patients with Inflammatory Bowel Disease

Kiely, Christopher J.; Clark, Angela; Bhattacharyya, Joya; Moran, Gordon W.; Lee, James C.; Parkes, Miles

Abstract

Background: Management of proctitis refractory to conventional therapies presents a common clinical problem. The use of acetarsol suppositories, which are derived from organic arsenic, was frst described in 1965. Data concerning clinical efficacy and tolerability are very limited.
Aim: To examine the efficacy of acetarsol suppositories for the treatment of refractory proctitis.
Methods: A retrospective analysis was performed on patients with infammatory bowel disease treated with acetarsol suppositories
between 2008 and 2014 at Addenbrooke’s Hospital, Cambridge, United Kingdom. Clinical response was defined as resolution of symptoms back to baseline at the time of next clinic review.
Results: Thirty-nine patients were prescribed acetarsol suppositories between March 2008 and July 2014 (29 patients with ulcerative colitis, nine with Crohn’s disease, and one with indeterminate colitis). Thirty-eight were included for analysis. The standard dose of acetarsol was 250 mg twice daily per rectum for 4 weeks. Clinical response was observed in 26 patients (68%). Of the 11 patients who had endoscopic assessment before and after treatment, nine (82%) showed endoscopic improvement and five (45%) were in complete remission (Wilcoxon signed-rank test p = 0.006). One patient developed a macular skin rash 1 week after commencing acetarsol, which resolved within 4 weeks of drug cessation.
Conclusion: Acetarsol was effective for two out of every three patients with refractory proctitis. This cohort had failed a broad range of topical and systemic treatments, including anti-TNFα therapy. Clinical efficacy was refected in significant endoscopic improvement. Adverse efects of acetarsol were rare.

Citation

Kiely, C. J., Clark, A., Bhattacharyya, J., Moran, G. W., Lee, J. C., & Parkes, M. (2018). Acetarsol Suppositories: Effective Treatment for Refractory Proctitis in a Cohort of Patients with Inflammatory Bowel Disease. Digestive Diseases and Sciences, 63(4), 1011-1015. https://doi.org/10.1007/s10620-017-4890-6

• Journal Article Type: Article
• Acceptance Date: Dec 13, 2017
• Online Publication Date: Feb 19, 2018
• Publication Date: 2018-04
• Deposit Date: Dec 13, 2018
• Publicly Available Date: Dec 14, 2018
• Journal: Digestive Diseases and Sciences
• Print ISSN: 0163-2116
• Electronic ISSN: 1573-2568
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 63
• Issue: 4
• Pages: 1011-1015
• DOI: https://doi.org/10.1007/s10620-017-4890-6
• Public URL: https://nottingham-repository.worktribe.com/output/1413135
• Publisher URL: https://link.springer.com/article/10.1007%2Fs10620-017-4890-6