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 evaluated eosinophilic esophagitis patients included into a large database since 2007 at the Swiss eosinophilic esophagitis Clinics put on swallowed topical corticosteroids as induction/maintenance therapy.
Disease activity was assessed on an annual basis.
In patients who achieved long-lasting (≥6 months) clinical, endoscopic, and histological (=deep) remission, treatment was stopped.
|9% who were treated with swallowed topical corticosteroids achieved deep remission|
|American Journal of Gastroenterology|
Data on all patients treated using this therapeutic strategy were analyzed retrospectively.
Of the 351 patients, the team found that 9% who were treated with swallowed topical corticosteroids achieved deep remission.
The research team found 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 team noted that swallowed topical corticosteroids were stopped after 105 weeks.
The researchers observed no mucosal damage was upon histological examination.
In 82% of the remitters, a clinical relapse occurred after a median of 22 weeks.
The team noted that 18% of remitters did not experience a clinical relapse during a follow-up of 35 weeks.
Hence, a total of 2% patients were able to discontinue swallowed topical corticosteroids in the long term.
Dr Greuter's 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."