EoE disease activity rapidly recurs with topical steroids
After an initial histologic response to topical steroids such as oral viscous budesonide or fluticasone from a multidose inhaler, researchers saw a rapid recurrence in eosinophilic esophagitis disease activity, according to results published in Clinical Gastroenterology and Hepatology.
“Because most subjects had recurrent endoscopic and histologic signs not reliably detected by symptoms, maintenance therapy should be recommended in EoE patients achieving histologic response to topical steroids,” Evan S. Dellon, MD, MPH, from the Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, division of gastroenterology and hepatology, and the department of pathology and laboratory medicine at the University of North Carolina School of Medicine in Chapel Hill, and colleagues wrote.
Dellon and colleagues performed a randomized, double-blind, double-dummy trial comparing oral viscous budesonide with fluticasone from a multidose inhaler as initial treatment for EoE in 58 patients. In the observation phase, 33 patients with a histologic response entered the observation phase where their treatment was discontinued and researchers monitored their symptoms. If symptoms recurred at 1 year, patients underwent either an endoscopy or biopsy. Time to symptom recurrence was analyzed and researchers then evaluated endoscopic severity and histologic relapse at the follow-up endoscopy.
At 1-year, investigators saw recurrence in 33 patients, with a median time to symptom recurrence of 244 days. The data showed no difference in the rate of symptom recurrence for patients treated with oral viscous budesonide compared with fluticasone from a multidose inhaler (HR = 1.04; 95% CI, 0.52–2.08). Researchers observed histologic relapse in 78% of patients at symptom recurrence. Compared with the end of treatment, patients had significant increases in the mean Dysphagia Symptom Questionnaire score (3.8 vs 8.7; P < .001), and the EoE Endoscopic Reference Score (1.3 vs 4.6; P < .001).
“In patients off treatment for up to a year, we observed recurrent esophageal eosinophilia, progression of stricture severity, loss of esophageal caliber gained from prior dilations, and recurrent symptoms,” Dellon and colleagues wrote. “These data justify the use of maintenance therapy in patients with EoE who achieve disease remission on topical/swallowed steroids.”