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Title: Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real-world efficacy from the EoE CONNECT registry.
Author: Laserna-Mendieta EJ, Navarro P, Casabona-Francés S, Savarino EV, Amorena E, Pérez-Martínez I, Guagnozzi D, Blas-Jhon L, Betoré E, Guardiola-Arévalo A, Pellegatta G, Krarup AL, Perello A, Barrio J, Gutiérrez-Junquera C, Teruel Sánchez-Vegazo C, Fernández-Fernández S, Naves JE, Oliva S, Rodríguez-Oballe JA, Carrión S, Espina S, Llorente Barrio M, Masiques-Mas ML, Dainese R, Feo-Ortega S, Martín-Dominguez V, Fernández-Pacheco J, Pérez-Fernández MT, Ghisa M, Maniero D, Nantes-Castillejo Ó, Nicolay-Maneru J, Suárez A, Maray I, Llerena-Castro R, Ortega-Larrodé A, Alcedo J, Granja Navacerrada A, Racca F, Santander C, Arias Á, Lucendo AJ, EUREOS and EoE CONNECT research group.
Journal: United European Gastroenterol J; 2024 Jun; 12(5):585-595. PubMed ID: 38284792.
Abstract:
BACKGROUND: Swallowed topical corticosteroids (tC) are common therapy for patients with eosinophilic esophagitis (EoE). Widely heterogeneous results have occurred due to their active ingredients, formulations and doses. OBJECTIVE: To assess the effectiveness of topical corticosteroid therapy for EoE in real-world practice. METHODS: Cross-sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high-power field. The effectiveness in achieving clinico-histological remission (CHR) was compared for the main tC formulations. RESULTS: Overall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first-line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8 mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4 mg/day provided no benefit over 2 mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p < 0.001); use of higher doses (OR 4.3, p = 0.03) and lower symptom scores (OR 0.9, p = 0.01) were also determinants of effectiveness. CONCLUSION: Reduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.

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