EFFeCtiveness AND SAFETY OF High versus low dose swallowed TopICal STEROIDs for Maintenance Treatment of Eosinophilic Esophagitis: A Multi-Center Observational Study.
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BORIS DOI
Date of Publication
December 2021
Publication Type
Article
Division/Institute
Contributor
Greuter, Thomas | |
Godat, Anne | |
Ringel, Amit | |
Almonte, Hector Samuel | |
Schupack, Daniel | |
Mendoza, Gabriela | |
McCright-Gill, Talaya | |
Dellon, Evan S | |
Hirano, Ikuo | |
Alexander, Jeffrey | |
Chehade, Mirna | |
Bussmann, Christian | |
Biedermann, Luc | |
Schreiner, Philipp | |
Schoepfer, Alain M | |
Straumann, Alex | |
Katzka, David A |
Series
Clinical gastroenterology and hepatology
ISSN or ISBN (if monograph)
1542-3565
Publisher
Elsevier
Language
English
Publisher DOI
PubMed ID
32798703
Uncontrolled Keywords
Description
BACKGROUND & AIMS
Data evaluating efficacy of different doses of swallowed topical corticosteroids (STC) in the long-term management of eosinophilic esophagitis (EoE) are lacking. We assessed long-term effectiveness and safety of different STC doses for adults with EoE after achievement of histological remission.
METHODS
We performed a retrospective multicenter study at five EoE referral centers (US and Switzerland). We analyzed data on 82 patients with EoE in histological remission and ongoing STC treatment with therapeutic adherence of >75% (58 males; mean age at diagnosis, 37.2±14.4 years). Patients were followed for a median of 2.2 years (interquartile range [IQR], 1.0-3.8 years). We collected data from 217 follow-up endoscopy visits. The primary endpoint was time to histological relapse.
RESULTS
Histological relapse occurred in 67% of patients. Relapse rates were comparable in patients taking low dose (<0.5 mg per day, n=58) and high dose STC (>0.5mg per day, n=24) with 72 vs. 54% (ns). However, histological relapse occurred significantly earlier with low dose STC (1.0 vs. 1.8 years, p=0.030). There was no difference regarding rates of and time to stricture formation for low vs. high dose STC. Esophageal candidiasis was observed in 6% of patients (5% for low dose, 8% for high dose, ns). No dysplasia or mucosal atrophy was detected.
CONCLUSION
Histological relapse frequently occurs in EoE despite ongoing STC treatment regardless of STC doses. However, relapse develops later in patients on high dose STC without an increase in side-effects. Doses higher than 0.5mg/day may be considered for EoE maintenance treatment, but advantage over lower doses appears to be small.
Data evaluating efficacy of different doses of swallowed topical corticosteroids (STC) in the long-term management of eosinophilic esophagitis (EoE) are lacking. We assessed long-term effectiveness and safety of different STC doses for adults with EoE after achievement of histological remission.
METHODS
We performed a retrospective multicenter study at five EoE referral centers (US and Switzerland). We analyzed data on 82 patients with EoE in histological remission and ongoing STC treatment with therapeutic adherence of >75% (58 males; mean age at diagnosis, 37.2±14.4 years). Patients were followed for a median of 2.2 years (interquartile range [IQR], 1.0-3.8 years). We collected data from 217 follow-up endoscopy visits. The primary endpoint was time to histological relapse.
RESULTS
Histological relapse occurred in 67% of patients. Relapse rates were comparable in patients taking low dose (<0.5 mg per day, n=58) and high dose STC (>0.5mg per day, n=24) with 72 vs. 54% (ns). However, histological relapse occurred significantly earlier with low dose STC (1.0 vs. 1.8 years, p=0.030). There was no difference regarding rates of and time to stricture formation for low vs. high dose STC. Esophageal candidiasis was observed in 6% of patients (5% for low dose, 8% for high dose, ns). No dysplasia or mucosal atrophy was detected.
CONCLUSION
Histological relapse frequently occurs in EoE despite ongoing STC treatment regardless of STC doses. However, relapse develops later in patients on high dose STC without an increase in side-effects. Doses higher than 0.5mg/day may be considered for EoE maintenance treatment, but advantage over lower doses appears to be small.
File(s)
File | File Type | Format | Size | License | Publisher/Copright statement | Content | |
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Greuter ClinGastroenterolHepatol 2020_AAM.pdf | Adobe PDF | 3.39 MB | Attribution-NonCommercial-NoDerivatives (CC BY-NC-ND 4.0) | accepted | |||
Greuter_ClinGastroenterolHepatol_2021.pdf | Adobe PDF | 1001.28 KB | publisher | published |