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 25 May 2018

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News

Long-term treatment of eosinophilic esophagitis with swallowed topical corticosteroids

The most recent issue of the American Journal of Gastroenterology examines the long-term treatment of eosinophilic esophagitis with swallowed topical corticosteroids.

News image

Swallowed topical corticosteroids are efficacious in inducing and presumably maintaining remission in patients with active eosinophilic esophagitis.

Hitherto, it has not been evaluated whether long-lasting remission can be achieved, and whether treatment can be stopped once patients have achieved this remission.

Dr Thomas Greuter and colleagues from Switzerland included eosinophilic esophagitis patients from a large database at the Swiss eosinophilic esophagitis Clinics, and put on swallowed topical corticosteroids as induction/maintenance therapy since 2007.

Disease activity was assessed on an annual basis.

In patients who achieved long-lasting clinical, endoscopic, and histological remission, treatment was stopped.

Data on all patients treated using this therapeutic strategy were analyzed retrospectively.

Deep remission was achieved after 89 weeks
American Journal of Gastroenterology

Of the 351 patients, the researchers found that 9% who were treated with swallowed topical corticosteroids achieved deep remission.

The research team observed that the median age of remitters at disease onset was 33 years, and diagnostic delay was 5 years.

The team noted that deep remission was achieved after 89 weeks.

Female gender was the only independent prognostic factor for achieving deep remission.

Overall, the research team noted that swallowed topical corticosteroids were stopped after almost 105 weeks.

No mucosal damage was observed upon histological examination.

In 82% of remitters, a clinical relapse occurred after a median of 22 weeks.

The researchers observed that 18% of remitters did not experience a clinical relapse during a follow-up of 35 weeks.

The team found that a total of 2% of patients were able to discontinue swallowed topical corticosteroids in the long term.

Dr Greuter's team concludes, "Long-term eosinophilic esophagitis treatment with swallowed topical corticosteroids was well tolerated, but only a minority achieved deep remission."

"Female gender is the only prognostic factor for attainment of such remission."

"After treatment cessation, the majority experienced a clinical relapse."

Am J Gastroenterol 2017; 112:1527–1535
10 October 2017

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