A pilot study of fluticasone propionate in untreated coeliac disease.

Abstract

Although gluten withdrawal is likely to remain the mainstay of treatment for adult coeliac disease, many patients find the diet inconvenient and unpalatable and compliance among asymptomatic patients is often poor. Oral corticosteroids have been used for patients who seem to be resistant to gluten withdrawal but preparations with low systemic bioavailability might be preferable. We have given a new glucocorticoid (fluticasone propionate) to 12 adults with untreated coeliac disease for six weeks while they were on a normal diet. One patient defaulted and one suffered a relapse in a pre-existing neoplasm. Excluding these, there was an improvement of symptoms, a mean weight gain of 2 kg, and a rise in albumin of 5 4 g/l. There was a significant improvement in the lactulose/mannitol excretion ratio (p<005) and in all histological variables examined in paired biopsy specimens (surface and crypt intraepithelial lymphocyte/enterocyte and goblet cell/enterocyte ratios and enterocyte height, p<001 or better). In six paired specimens sucrase and alkaline phosphatase activity increased in all (p<0.05) and lactase in five of six. No appreciable side effects were observed, but two patients had suppressed cortisol values and synacthen responses at six weeks. A further three, with normal pretrial results, had a blunted tetracosactrin response at six weeks. Fluticasone propionate seems worthy of further assessment in the treatment of coeliac disease as an adjunct to gluten withdrawal. Gastroenterology Unit H C Mitchison

The Role of Corticosteroids in Celiac Disease

“…This success was later translated into a clinical study: Bramble et al [9] reported symptomatic improvement in patients taking locally active corticosteroids despite their continuation of a regular diet. These results were later confirmed by Mitchison et al [10], who reported clinical and histological improvement in celiac patients consuming a regular diet while taking a locally active corticosteroid. The success of these studies was somewhat mitigated by the finding that systemic corticosteroid absorption occurred.…”

Azathioprine and prednisone combination therapy in refractory coeliac disease

“…It might be expected that immunosuppressive treatment moderates this overactivity and thus might be a valuable treatment option. The use of several immunosuppressive treatment strategies such as corticosteroids, cyclosporin and interleukin‐10 (IL‐10) has been described in RCD patients and untreated coeliac disease patients, mainly in case reports, but with disappointing results in the majority of cases 14–22 . Of course, the positive effects of corticosteroids 16 , 20 are counteracted by their disadvantages, such as fluid retention and osteoporosis.…”

Efficacy of budesonide therapy in the early phase of treatment of adult coeliac disease patients with malabsorption: An in vivo/in vitro pilot study

“…Bramble et al 29 . and Mitchison et al 30 . used topically active corticosteroids in patients with coeliac disease that were on a regular diet and noted improvements in both histology and parameters of absorption.…”

“…27,28 Second, this class of drug has been demonstrated to be efficacious in coeliac disease. Bramble et al 29 and Mitchison et al 30 used topically active corticosteroids in patients with coeliac disease that were on a regular diet and noted improvements in both histology and parameters of absorption. Budesonide is currently used in the treatment of refractory coeliac disease and in enteropathy associated T cell lymphoma.…”