Even after initial histologic response to induction therapy, eosinophilic esophagitis recurs rapidly in patients who discontinue treatment, regardless of the type of medication used, according to results of a randomized controlled trial.
Evan S. Dellon, MD, MPH, director of the Center for Esophageal Diseases and Swallowing at the University of North Carolina School of Medicine, and colleagues wrote that topical steroids typically show benefit among patients who fail to respond to proton pump inhibitors, but not much is known about what happens if those medications are not continued after induction.
“There are few data available regarding durability of response, but these suggest a relatively rapid recurrence of symptoms and histologic activity,” they wrote. “Providers need high-quality data to accurately inform patients regarding the likelihood and timing of recurrent symptoms and esophageal eosinophilia after an initially successful treatment course. A better understanding of durability of response would also inform decisions regarding which patients with EoE might need long-term therapy.”
During a randomized controlled trial that compared oral viscous budesonide with a fluticasone inhaler as an initial treatment for EoE, researchers selected patients who achieved histologic response to participate in an observational study (< 15 eosinophils/high-power field; n = 58). They observed patients after they discontinued treatment who then underwent endoscopy and biopsy at 1 year or when symptoms recurred.
Investigators found that 57% of patients experienced symptom recurrence before 1 year with an overall median time to recurrence of 244 days. There was no difference in time to recurrence between patients who received an initial treatment of budesonide or fluticasone.
At the time of symptom recurrence, 78% of patients had histologic relapse.
Dellon and colleagues wrote that this showed a poor agreement between symptoms and histologic relapse.
“Symptoms do not appear to be a reliable indicator of long-term disease control after initial remission in the setting of medication discontinuation, and even patients who were ‘asymptomatic’ still had measurable symptom scores using validated instruments,” they wrote. “Given the rapidity of symptom recurrence and associated histologic and endoscopic activity, maintenance therapy for EoE seems to be well justified.” – by Alex Young
Disclosures: Dellon reports he received research funding from Adare, Allakos, Celgene/Receptos, GlaxoSmithKline, Meritage, Miraca, Nutricia, Regeneron and Shire, consultant fees from Adare, Alivio, Allakos, AstraZeneca, Banner, Biorasi, Calypso, Celgene/Receptos, Enumeral, EsoCap, Gossamer Bio, GlaxoSmithKline, Regeneron, Robarts, Salix and Shire, and educational grants from Allakos, Banner and Holoclara. Please see the study for all other authors’ relevant financial disclosures.