Thomas Greuter1, Christian Bussmann2, Ekaterina Safroneeva3, Alain M Schoepfer4, Luc Biedermann1, Stephan R Vavricka1,5, Alex Straumann6. 1. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland. 2. Pathology Viollier AG, Basel, Switzerland. 3. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. 4. Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland. 5. Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Zurich, Switzerland. 6. Swiss EoE Clinics, Praxis Römerhof, Olten, Switzerland.
Abstract
OBJECTIVES: Swallowed topical corticosteroids (STCs) are efficacious in inducing and presumably maintaining remission in patients with active eosinophilic esophagitis (EoE). Hitherto, it has not been evaluated whether long-lasting remission can be achieved, and whether treatment can be stopped once patients have achieved this remission. METHODS: Since 2007, EoE patients included into a large database at the Swiss EoE Clinics were put on STCs as induction/maintenance therapy. Disease activity was assessed on an annual basis. In patients who achieved long-lasting (≥6 months) clinical, endoscopic, and histological (=deep) remission, treatment was stopped. Data on all patients treated using this therapeutic strategy were analyzed retrospectively. RESULTS: Of the 351 patients, 33 (9.4%) who were treated with STCs achieved deep remission. Median age of remitters at disease onset was 32.6 years (interquartile range (IQR) 19.1-49.3), and diagnostic delay was 5.4 years (IQR 1.2-11.4). Deep remission was achieved after 89.0 weeks (IQR 64.6-173.8). Female gender was the only independent prognostic factor for achieving deep remission (odds ratio (OR) 2.518, 95% confidence interval (CI) 1.203-5.269). Overall, STCs were stopped after 104.7 weeks (IQR 65.5-176.6). No mucosal damage was observed upon histological examination. In 27 of the 33 remitters (81.8%), a clinical relapse occurred after a median of 22.4 weeks (95% CI 5.1-39.7). Six remitters (18.2%) did not experience a clinical relapse during a follow-up of 35.1 weeks (IQR 18.3-44.9). Hence, a total of 1.7% (6/351) patients were able to discontinue STCs in the long term. CONCLUSIONS: Long-term EoE treatment with STCs was well tolerated, but only a minority achieved deep remission. Female gender is the only prognostic factor for attainment of such remission. After treatment cessation, the majority experienced a clinical relapse.
OBJECTIVES: Swallowed topical corticosteroids (STCs) are efficacious in inducing and presumably maintaining remission in patients with active eosinophilic esophagitis (EoE). Hitherto, it has not been evaluated whether long-lasting remission can be achieved, and whether treatment can be stopped once patients have achieved this remission. METHODS: Since 2007, EoE patients included into a large database at the Swiss EoE Clinics were put on STCs as induction/maintenance therapy. Disease activity was assessed on an annual basis. In patients who achieved long-lasting (≥6 months) clinical, endoscopic, and histological (=deep) remission, treatment was stopped. Data on all patients treated using this therapeutic strategy were analyzed retrospectively. RESULTS: Of the 351 patients, 33 (9.4%) who were treated with STCs achieved deep remission. Median age of remitters at disease onset was 32.6 years (interquartile range (IQR) 19.1-49.3), and diagnostic delay was 5.4 years (IQR 1.2-11.4). Deep remission was achieved after 89.0 weeks (IQR 64.6-173.8). Female gender was the only independent prognostic factor for achieving deep remission (odds ratio (OR) 2.518, 95% confidence interval (CI) 1.203-5.269). Overall, STCs were stopped after 104.7 weeks (IQR 65.5-176.6). No mucosal damage was observed upon histological examination. In 27 of the 33 remitters (81.8%), a clinical relapse occurred after a median of 22.4 weeks (95% CI 5.1-39.7). Six remitters (18.2%) did not experience a clinical relapse during a follow-up of 35.1 weeks (IQR 18.3-44.9). Hence, a total of 1.7% (6/351) patients were able to discontinue STCs in the long term. CONCLUSIONS: Long-term EoE treatment with STCs was well tolerated, but only a minority achieved deep remission. Female gender is the only prognostic factor for attainment of such remission. After treatment cessation, the majority experienced a clinical relapse.
Authors: Chris A Liacouras; Glenn T Furuta; Ikuo Hirano; Dan Atkins; Stephen E Attwood; Peter A Bonis; A Wesley Burks; Mirna Chehade; Margaret H Collins; Evan S Dellon; Ranjan Dohil; Gary W Falk; Nirmala Gonsalves; Sandeep K Gupta; David A Katzka; Alfredo J Lucendo; Jonathan E Markowitz; Richard J Noel; Robert D Odze; Philip E Putnam; Joel E Richter; Yvonne Romero; Eduardo Ruchelli; Hugh A Sampson; Alain Schoepfer; Nicholas J Shaheen; Scott H Sicherer; Stuart Spechler; Jonathan M Spergel; Alex Straumann; Barry K Wershil; Marc E Rothenberg; Seema S Aceves Journal: J Allergy Clin Immunol Date: 2011-04-07 Impact factor: 10.793
Authors: Elizabeth T Schaefer; Joseph F Fitzgerald; Jean P Molleston; Joseph M Croffie; Marian D Pfefferkorn; Mark R Corkins; Joel D Lim; Steven J Steiner; Sandeep K Gupta Journal: Clin Gastroenterol Hepatol Date: 2008-02 Impact factor: 11.382
Authors: Glenn T Furuta; Chris A Liacouras; Margaret H Collins; Sandeep K Gupta; Chris Justinich; Phil E Putnam; Peter Bonis; Eric Hassall; Alex Straumann; Marc E Rothenberg Journal: Gastroenterology Date: 2007-08-08 Impact factor: 22.682
Authors: Fouad J Moawad; Evan S Dellon; Sami R Achem; Tony Ljuldjuraj; Daniel J Green; Corinne L Maydonovitch; Diana R Brizuela; Sandeep K Gupta; Mirna Chehade Journal: Clin Gastroenterol Hepatol Date: 2015-09-04 Impact factor: 11.382
Authors: Tetsuo Shoda; Ting Wen; Seema S Aceves; J Pablo Abonia; Dan Atkins; Peter A Bonis; Julie M Caldwell; Kelley E Capocelli; Christina L Carpenter; Margaret H Collins; Evan S Dellon; Michael D Eby; Nirmala Gonsalves; Sandeep K Gupta; Gary W Falk; Ikuo Hirano; Paul Menard-Katcher; Jonathan T Kuhl; Jeffrey P Krischer; John Leung; Vincent A Mukkada; Jonathan M Spergel; Michael P Trimarchi; Guang-Yu Yang; Nives Zimmermann; Glenn T Furuta; Marc E Rothenberg Journal: Lancet Gastroenterol Hepatol Date: 2018-05-03
Authors: Seema S Aceves; Eileen King; Margaret H Collins; Guang-Yu Yang; Kelley E Capocelli; J Pablo Abonia; Dan Atkins; Peter A Bonis; Christina L Carpenter; Evan S Dellon; Michael D Eby; Gary W Falk; Nirmala Gonsalves; Sandeep K Gupta; Ikuo Hirano; Kendra Kocher; Jeffrey P Krischer; John Leung; Jessi Lipscomb; Paul Menard-Katcher; Vincent A Mukkada; Zhaoxing Pan; Jonathan M Spergel; Qin Sun; Barry K Wershil; Marc E Rothenberg; Glenn T Furuta Journal: J Allergy Clin Immunol Date: 2018-05-29 Impact factor: 10.793
Authors: Daniel A Schupack; Karthik Ravi; Debra M Geno; Katrina Pierce; Kristin Mara; David A Katzka; Jeffrey A Alexander Journal: Dig Dis Sci Date: 2020-03-12 Impact factor: 3.199
Authors: Brittany T Hines; Matthew A Rank; Benjamin L Wright; Lisa A Marks; John B Hagan; Alex Straumann; Matthew Greenhawt; Evan S Dellon Journal: Ann Allergy Asthma Immunol Date: 2018-05-16 Impact factor: 6.347