Maintenance Treatment Of Eosinophilic Esophagitis With Swallowed Topical Steroids Alters Disease Course Over A 5-Year Follow-up Period In Adult Patients

Thomas Greuter, Ekaterina Safroneeva, Christian Bussmann, Luc Biedermann, Stephan R. Vavricka, David A Katzka, Alain M. Schoepfer, Alex Straumann

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)419-428.e6
JournalClinical Gastroenterology and Hepatology
Volume17
Issue number3
DOIs
StatePublished - Feb 1 2019

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Eosinophilic Esophagitis
Adrenal Cortex Hormones
Steroids
Therapeutics
Databases
Candidiasis
Atrophy

Keywords

  • Esophagus
  • Long-term Outcome
  • Predictive Factors
  • Response to Therapy

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Maintenance Treatment Of Eosinophilic Esophagitis With Swallowed Topical Steroids Alters Disease Course Over A 5-Year Follow-up Period In Adult Patients. / Greuter, Thomas; Safroneeva, Ekaterina; Bussmann, Christian; Biedermann, Luc; Vavricka, Stephan R.; Katzka, David A; Schoepfer, Alain M.; Straumann, Alex.

In: Clinical Gastroenterology and Hepatology, Vol. 17, No. 3, 01.02.2019, p. 419-428.e6.

Research output: Contribution to journalArticle

Greuter, Thomas ; Safroneeva, Ekaterina ; Bussmann, Christian ; Biedermann, Luc ; Vavricka, Stephan R. ; Katzka, David A ; Schoepfer, Alain M. ; Straumann, Alex. / Maintenance Treatment Of Eosinophilic Esophagitis With Swallowed Topical Steroids Alters Disease Course Over A 5-Year Follow-up Period In Adult Patients. In: Clinical Gastroenterology and Hepatology. 2019 ; Vol. 17, No. 3. pp. 419-428.e6.
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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.",
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AU - Greuter, Thomas

AU - Safroneeva, Ekaterina

AU - Bussmann, Christian

AU - Biedermann, Luc

AU - Vavricka, Stephan R.

AU - Katzka, David A

AU - Schoepfer, Alain M.

AU - Straumann, Alex

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Y1 - 2019/2/1

N2 - 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.

AB - 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.

KW - Esophagus

KW - Long-term Outcome

KW - Predictive Factors

KW - Response to Therapy

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