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Observational Study
. 2021 Dec;19(12):2514-2523.e2.
doi: 10.1016/j.cgh.2020.08.027. Epub 2020 Aug 13.

Effectiveness and Safety of High- vs Low-Dose Swallowed Topical Steroids for Maintenance Treatment of Eosinophilic Esophagitis: A Multicenter Observational Study

Thomas Greuter  1 , Anne Godat  2 , Amit Ringel  3 , Hector Samuel Almonte  4 , Daniel Schupack  5 , Gabriela Mendoza  6 , Talaya McCright-Gill  6 , Evan S Dellon  3 , Ikuo Hirano  4 , Jeffrey Alexander  5 , Mirna Chehade  6 , Ekaterina Safroneeva  7 , Christian Bussmann  8 , Luc Biedermann  9 , Philipp Schreiner  9 , Alain M Schoepfer  10 , Alex Straumann  9 , David A Katzka  5
Affiliations
Observational Study

Effectiveness and Safety of High- vs Low-Dose Swallowed Topical Steroids for Maintenance Treatment of Eosinophilic Esophagitis: A Multicenter Observational Study

Thomas Greuter et al. Clin Gastroenterol Hepatol. 2021 Dec.

Abstract

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 (>0.5 mg 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 = .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 0.5 mg/day may be considered for EoE maintenance treatment, but advantage over lower doses appears to be small.

Keywords: Esophagus; Long-Term Outcome; Relapse; Response to Therapy; Swallowed Topical Corticosteroids.

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Figures

Figure 1:
Figure 1:
Study flow chart
Figure 2:
Figure 2:
Kaplan Meier curves for time to histological relapse (A), time to bolus removal (B) and time to stricture formation (C) in all patients stratified by steroid dose groups.
Figure 3:
Figure 3:
Kaplan Meier curves for time to histological relapse (A) and time to stricture formation (B) in patients with deep histological remission at baseline stratified by steroid dose groups.
See this image and copyright information in PMC

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