Thomas Greuter1, Ekaterina Safroneeva2, Christian Bussmann3, Luc Biedermann4, Stephan R Vavricka4, David A Katzka5, Alain M Schoepfer6, Alex Straumann4. 1. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota. Electronic address: thomas.greuter@usz.ch. 2. Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland. 3. Pathology Viollier AG, Basel, Switzerland. 4. Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland. 5. Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, Minnesota. 6. Division of Gastroenterology and Hepatology, University Hospital Lausanne - Centre Hopitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
Abstract
BACKGROUND & AIMS: Although swallowed topical corticosteroids (STCs) are effective in inducing remission of active eosinophilic esophagitis (EoE), there are few data on maintenance of long-term remission. We evaluated the long-term effectiveness of STC therapy for adults with EoE. METHODS: We performed a retrospective study using the Swiss EoE database. We analyzed data on 229 patients with EoE treated with STCs (175 male; mean age at diagnosis, 39±15 years; median time until diagnosis, 6 years) from 2000 through 2014. Patients were followed for a median of 5 years (interquartile range [IQR], 3-7 years). We collected data from 819 follow-up visits on clinical, endoscopic and histological disease characteristics. The primary endpoint was proportions of clinical, endoscopic, and histological remission in all patients and groups, based on the status and duration of STC treatment. RESULTS: Patients were taking STCs at 336 of the follow-up visits (41.0% of visits). The median duration of STC use before a follow-up visit was 347 days (IQR, 90-750 days) corresponding to 677 doses (IQR, 280-1413 doses) of 0.25 mg each. At the visits, higher proportions of patients who were still taking STCs were in clinical remission (31.0%) compared to patients not taking STCs (4.5%) (P <.001), as well as endoscopic remission (48.8% vs 17.8%; P < .001), histologic remission (44.8% vs 10.1%; P < .001), and complete remission (16.1% vs 1.3%; P < .001). Higher cumulative doses of STCs and longer durations of treatment were associated with higher proportions of clinical and complete remission. No dysplasia or mucosal atrophy was detected. Esophageal candidiasis was observed at 2.7% of visits in patients taking STCs. CONCLUSION: In an analysis of data from the Swiss EoE database, we found maintenance therapy with STCs to achieve complete remission at 16.1% of follow-up visits, which was higher than in patients receiving no treatment (1.3%). Given the good safety profile of low-dose STC, we advocate for a prolonged treatment. Dose-finding trials are needed to achieve higher remission rates.
BACKGROUND & AIMS: Although swallowed topical corticosteroids (STCs) are effective in inducing remission of active eosinophilic esophagitis (EoE), there are few data on maintenance of long-term remission. We evaluated the long-term effectiveness of STC therapy for adults with EoE. METHODS: We performed a retrospective study using the Swiss EoE database. We analyzed data on 229 patients with EoE treated with STCs (175 male; mean age at diagnosis, 39±15 years; median time until diagnosis, 6 years) from 2000 through 2014. Patients were followed for a median of 5 years (interquartile range [IQR], 3-7 years). We collected data from 819 follow-up visits on clinical, endoscopic and histological disease characteristics. The primary endpoint was proportions of clinical, endoscopic, and histological remission in all patients and groups, based on the status and duration of STC treatment. RESULTS:Patients were taking STCs at 336 of the follow-up visits (41.0% of visits). The median duration of STC use before a follow-up visit was 347 days (IQR, 90-750 days) corresponding to 677 doses (IQR, 280-1413 doses) of 0.25 mg each. At the visits, higher proportions of patients who were still taking STCs were in clinical remission (31.0%) compared to patients not taking STCs (4.5%) (P <.001), as well as endoscopic remission (48.8% vs 17.8%; P < .001), histologic remission (44.8% vs 10.1%; P < .001), and complete remission (16.1% vs 1.3%; P < .001). Higher cumulative doses of STCs and longer durations of treatment were associated with higher proportions of clinical and complete remission. No dysplasia or mucosal atrophy was detected. Esophageal candidiasis was observed at 2.7% of visits in patients taking STCs. CONCLUSION: In an analysis of data from the Swiss EoE database, we found maintenance therapy with STCs to achieve complete remission at 16.1% of follow-up visits, which was higher than in patients receiving no treatment (1.3%). Given the good safety profile of low-dose STC, we advocate for a prolonged treatment. Dose-finding trials are needed to achieve higher remission rates.
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: Cathleen A Collins; Jacob Palmquist; James A Proudfoot; Alex Qian; Hannah Wangberg; Emad Khosh-Hemmat; Ranjan Dohil; Seema S Aceves Journal: J Allergy Clin Immunol Date: 2019-06-28 Impact factor: 10.793
Authors: Thomas Greuter; Anne Godat; Amit Ringel; Hector Samuel Almonte; Daniel Schupack; Gabriela Mendoza; Talaya McCright-Gill; Evan S Dellon; Ikuo Hirano; Jeffrey Alexander; Mirna Chehade; Ekaterina Safroneeva; Christian Bussmann; Luc Biedermann; Philipp Schreiner; Alain M Schoepfer; Alex Straumann; David A Katzka Journal: Clin Gastroenterol Hepatol Date: 2020-08-13 Impact factor: 11.382