EFFeCtiveness AND SAFETY OF High versus low dose swallowed TopICal STEROIDs for Maintenance Treatment of Eosinophilic Esophagitis: A Multi-Center Observational Study.

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; Safroneeva, Ekaterina; Bussmann, Christian; Biedermann, Luc; Schreiner, Philipp; Schoepfer, Alain M; Straumann, Alex; Katzka, David A (2021). EFFeCtiveness AND SAFETY OF High versus low dose swallowed TopICal STEROIDs for Maintenance Treatment of Eosinophilic Esophagitis: A Multi-Center Observational Study. Clinical gastroenterology and hepatology, 19(12), 2514-2523.e2. Elsevier 10.1016/j.cgh.2020.08.027

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)

UniBE Contributor:

Safroneeva, Ekaterina

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1542-3565

Publisher:

Elsevier

Funders:

[4] Swiss National Science Foundation

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

26 Aug 2020 12:54

Last Modified:

17 Nov 2021 00:10

Publisher DOI:

10.1016/j.cgh.2020.08.027

PubMed ID:

32798703

Uncontrolled Keywords:

esophagus long-term outcome relapse response to therapy swallowed topical corticosteroids

BORIS DOI:

10.7892/boris.146095

URI:

https://boris.unibe.ch/id/eprint/146095

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