Rapid Recurrence of Eosinophilic Esophagitis After Successful Treatment

EoE activity rapidly recurred after initial response to oral viscous budesonide (OVB) or fluticasone from a multidose inhaler (MDI), indicating the need for maintenance therapy for patients who achieve histologic response to topical steroids.

Eosinophilic esophagitis (EoE) activity rapidly recurred after initial response to oral viscous budesonide (OVB) or fluticasone from a multidose inhaler (MDI), indicating the need for maintenance therapy for patients who achieve histologic response to topical steroids, according to a study published in Clinical Gastroenterology and Hepatology.  

EoE is chronic and appears to recur with cessation of treatment. This randomized, double-blind, double-dummy trial compared OVB to MDI for initial EoE treatment. Participants showing histologic response (<15 eosinophils/high-power field [eos/hpf]) during the randomized phase of the trial entered an observation phase, during which treatment was discontinued and symptoms were monitored. When symptoms recurred or at 1-year follow-up, participants underwent biopsy or endoscopy. Time to symptom recurrence was analyzed, and endoscopic severity according to EoE Endoscopic Reference Score and histologic relapse (≥15 eos/hpf) were assessed.

Fifty-seven percent of the 58 participants (n=33) experienced symptom recurrence before 1 year, with a median time to recurrence of 244 days. No significant difference in rate of symptom recurrence was seen between OVB participants (263 days) and MDI participants (224 days; P =.91) (hazard ratio 1.04; 95% CI, 0.52-2.08). Of the participants who underwent endoscopy and had complete outcome assessments, the Dysphagia Symptom Questionnaire score more than doubled compared to start of observation phase (3.8 vs 8.7; P <.001), and participants also showed significant increases in mean EoE Endoscopic Reference Score (1.3 vs 4.6; P <.001). Overall, 78% of participants experienced histological relapse, and 94% showed some degree of eosinophilic infiltration on biopsy (≥1 eos/hpf).

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Although the study was limited by a small sample size taken from a single referral center, study investigators conclude that these findings “justify the use of maintenance therapy in patients with EoE who achieve disease remission on topical/swallowed steroids.  The optimal long-term dose of topical steroids, potential for adverse events, and need for safety data remain areas that require future study.”

Disclosure: One study author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Dellon ES, Woosley JT, Arrington A, et al. Rapid recurrence of eosinophilic esophagitis activity after successful treatment in the observation phase of a randomized, double-blind, double-dummy trial [published online September 6, 2019]. Clin Gastroenterol Hepatol. doi: 10.1016/j.cgh.2019.08.050