Treatment of refractory diarrhoea in AIDS with acetorphan and octreotide: a randomized crossover study.

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Treatment of refractory diarrhoea in AIDS with acetorphan and octreotide: a randomized crossover study.

Eur J Gastroenterol Hepatol. 1996 May;8(5):485-9. Unique Identifier : AIDSLINE MED/96397994
Beaugerie L; Baumer P; Chaussade S; Berard H; Rozenbaum W; Pialoux G; Le Quintrec Y; Schwartz JC; Lecomte JM; Hopital Rothschild, Paris, France.

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. DESIGN: An open randomized crossover trial. SETTING: The inpatient medical units of three hospitals. PATIENTS: 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. INTERVENTIONS: Acetorphan (100-300 mg thrice daily) and octreotide (50-150 micrograms thrice daily) were given in random order during two 1-week periods. MAIN OUTCOME MEASURES: 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. CONCLUSION: Enkephalinase inhibitors may be a useful alternative to somatostatin analogues in the management of refractory diarrhoea in AIDS.

Keywords: *Antidiarrheals/THERAPEUTIC USE *Gastrointestinal Agents/THERAPEUTIC USE *HIV Enteropathy/DRUG THERAPY *Octreotide/THERAPEUTIC USE *Protease Inhibitors/THERAPEUTIC USE *Thiorphan/ANALOGS & DERIVATIVES
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