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Relapse in Eosinophilic Esophagitis Occurs Despite Treatment With Swallowed Topical Corticosteroids

Prateek Sharma, MD, FASGE, reviewing Greuter T, et al. Clin Gastroenterol Hepatol 2020 Aug 13.

Swallowed topical corticosteroids (STC) are effective as initial treatment in patients with eosinophilic esophagitis (EoE) and in achieving histological remission. However, their role in the long-term management of EoE is not clear. 

This multicenter observational study of 5 centers in the U.S. and Switzerland reported the effectiveness and safety of patients receiving ≤0.5 mg fluticasone or budesonide (low-dose STC) or >0.5 mg (high-dose STC) for a primary outcome of histological relapse (≥15 eosinophils per high-power field [eos/hpf]) after at least 1 follow-up endoscopy. Of 82 patients included in the study, 58 received low-dose STC and 24 were treated with high-dose STC. The majority of patients (93%) were treated with twice-daily dosing. Despite achieving initial histological remission (<15 eos/hpf), 45 of these patients had ongoing EoE-related symptoms, 11 of whom required endoscopic dilation for symptoms, including dysphagia, bolus impaction, and stricture. In addition, histological relapse occurred in 67% of the overall treated patients (72%, low-dose STC; 54%, high-dose STC). Relapse occurred significantly earlier in the low-dose STC group at 1-year follow-up versus 1.8-year follow-up for the high-dose STC recipients. Esophageal candidiasis was documented in 6% of the treated patients with no significant difference between treatment groups.

Prateek Sharma, MD, FASGE

COMMENT

Although swallowed topical steroids are effective in the initial treatment of patients with EoE, approximately 70% of these patients will have relapse during follow-up despite ongoing treatment.  Relapse is not dependent on the steroid treatment dose, but time to relapse does occur significantly earlier in those receiving low-dose treatment.

 

 

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

CITATION(S)

Greuter T, Godat A, Ringel A, et al. EFFeCtiveness AND SAFETY OF High versus low dose swallowed TopICal STEROIDs for maintenance treatment of eosinophilic esophagitis: a multi-center observational study. Clin Gastroenterol Hepatol 2020 Aug 13. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.08.027)

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