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ABSTRACT: Background & aims
Data evaluating efficacy of different doses of swallowed topical corticosteroids (STC) in the long-term management of eosinophilic esophagitis (EoE) are lacking. We assessed long-term effectiveness and safety of different STC doses for adults with EoE after achievement of histological remission.Methods
We performed a retrospective multicenter study at five EoE referral centers (US and Switzerland). We analyzed data on 82 patients with EoE in histological remission and ongoing STC treatment with therapeutic adherence of ≥75% (58 males; mean age at diagnosis, 37.2±14.4 years). Patients were followed for a median of 2.2 years (interquartile range [IQR], 1.0-3.8 years). We collected data from 217 follow-up endoscopy visits. The primary endpoint was time to histological relapse.Results
Histological relapse occurred in 67% of patients. Relapse rates were comparable in patients taking low dose (≤0.5 mg per day, n = 58) and high dose STC (>0.5 mg per day, n = 24) with 72 vs 54% (ns). However, histological relapse occurred significantly earlier with low dose STC (1.0 vs 1.8 years, P = .030). There was no difference regarding rates of and time to stricture formation for low vs high dose STC. Esophageal candidiasis was observed in 6% of patients (5% for low dose, 8% for high dose, ns). No dysplasia or mucosal atrophy was detected.Conclusion
Histological relapse frequently occurs in EoE despite ongoing STC treatment regardless of STC doses. However, relapse develops later in patients on high dose STC without an increase in side-effects. Doses higher than 0.5 mg/day may be considered for EoE maintenance treatment, but advantage over lower doses appears to be small.
SUBMITTER: Greuter T
PROVIDER: S-EPMC8108396 | biostudies-literature | 2021 Dec
REPOSITORIES: biostudies-literature
Greuter Thomas T Godat Anne A Ringel Amit A Almonte Hector Samuel HS Schupack Daniel D Mendoza Gabriela G McCright-Gill Talaya T Dellon Evan S ES Hirano Ikuo I Alexander Jeffrey J Chehade Mirna M Safroneeva Ekaterina E Bussmann Christian C Biedermann Luc L Schreiner Philipp P Schoepfer Alain M AM Straumann Alex A Katzka David A DA
Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 20200813 12
<h4>Background & aims</h4>Data evaluating efficacy of different doses of swallowed topical corticosteroids (STC) in the long-term management of eosinophilic esophagitis (EoE) are lacking. We assessed long-term effectiveness and safety of different STC doses for adults with EoE after achievement of histological remission.<h4>Methods</h4>We performed a retrospective multicenter study at five EoE referral centers (US and Switzerland). We analyzed data on 82 patients with EoE in histological remissi ...[more]