Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 31.
doi: 10.14309/ajg.0000000000003449. Online ahead of print.

Loss of Response to Off-Label Swallowed Topical Corticosteroids in Eosinophilic Esophagitis Can be Overcome by a Switch to an Esophageal-Targeted Budesonide Formulation

Fritz R Murray  1 , Jean-Benoit Rossel  2 , Ekaterina Safroneeva  3 , Catherine Saner  4 , Bernhard Morell  1 , Andrea Kreienbuehl  5 , Thomas Greuter  6 , Alex Straumann  5 , Luc Biedermann  5 , Alain Schoepfer  4 , Philipp Schreiner  7
Affiliations

Loss of Response to Off-Label Swallowed Topical Corticosteroids in Eosinophilic Esophagitis Can be Overcome by a Switch to an Esophageal-Targeted Budesonide Formulation

Fritz R Murray et al. Am J Gastroenterol. .

Abstract

Introduction: Swallowed topical corticosteroids (STCs) are effective in treating patients with eosinophilic esophagitis. However, real-world data about loss of response to STC are limited and whether patients with off-label STC (olSTC) failure may achieve histologic remission after a switch to budesonide orodispersible tablets (BOT) is unknown.

Methods: We analyzed prospectively collected data between 2015 and 2023 from the Swiss Eosinophilic Esophagitis Cohort Study and compared patients with prior histologic olSTC-failure (≥15 eosinophils per high-power field), histologic remission after olSTC (<15 eosinophils per high-power field), and STC-naïve patients before BOT treatment. Furthermore, we evaluated the course of olSTC-failure patients after a switch to BOT and used logistic regression to explore potential associations between patients with olSTC-failure and clinical factors.

Results: A total of 340 patients (76% male, median age = 43 years) with BOT were analyzed. Twenty-six percent had prior olSTC nonresponse, 16% were in remission with prior olSTC, and 58% were STC-naïve. In the multivariable logistic regression, olSTC treatment duration in years (OR 1.37, 95% CI 1.12-1.67, P = 0.002), off-label STC adherence <80% in the last 2 years before BOT (6.30; 1.19-33.29, P = 0.03), and age <30 years (6.57; 1.85-23.37, P = 0.004) were independently associated with histologic nonresponse to olSTC. Histologic or combined remission to BOT was not different in patients with prior olSTC response (n = 44) compared to patients nonresponded to olSTC (n = 66) (77.3% vs 62.1%, P = 0.095 and 61.4% vs 42.4%, P = 0.052).

Discussion: Most patients nonresponding to olSTC are not true corticosteroid-refractory but respond to an esophageal-targeted budesonide formulation. Age below 30 years, longer treatment duration and low adherence are associated with olSTC-failure.

Keywords: Budesonide orodispersible tablets; Eosinophilic Esophagitis; esophageal-targeted budesonide formulation; off-label corticosteroids.

PubMed Disclaimer

References

    1. Hahn JW, Lee K, Shin JI, et al. Global incidence and prevalence of eosinophilic esophagitis, 1976-2022: A systematic review and meta-analysis. Clin Gastroenterol Hepatol 2023;21(13):3270–84.e77.
    1. Laserna-Mendieta EJ, Casabona S, Savarino E, et al. Efficacy of therapy for eosinophilic esophagitis in real-world practice. Clin Gastroenterol Hepatol 2020;18(13):2903–11.e4.
    1. Safroneeva E, Saner C, Rossel JB, et al. Cohort profile: The Swiss eosinophilic esophagitis cohort study (SEECS). Inflamm Intest Dis 2018;2(3):163–70.
    1. Schreiner P, Balcar L, Schlager H, et al. Management of suspected and known eosinophilic esophagitis-a nationwide survey in Austria. Wien Klin Wochenschr 2023;135(15-16):406–13.
    1. de Heer J, Miehlke S, Rösch T, et al. Histologic and clinical effects of different topical corticosteroids for eosinophilic esophagitis: Lessons from an updated meta-analysis of placebo-controlled randomized trials. Digestion 2021;102(3):377–85.

LinkOut - more resources