Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real-world efficacy from the EoE CONNECT registry.
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Laserna-Mendieta Emilio J, Navarro Pilar, Casabona-Francés Sergio, Savarino Edoardo V, Amorena Edurne, Pérez-Martínez Isabel, Guagnozzi Danila, Blas-Jhon Leonardo, Betoré Elena, Guardiola-Arévalo Antonio, Pellegatta Gaia, Krarup Anne Lund, Perello Antonia, Barrio Jesús, Gutiérrez-Junquera Carolina, Teruel Sánchez-Vegazo Carlos, Fernández-Fernández Sonia, Naves Juan Enrique, Oliva Salvatore, Rodríguez-Oballe Juan Armando, Carrión Silvia, Espina Silvia, Llorente Barrio Mónica, Masiques-Mas Maria Lluisa, Dainese Raffaella, Feo-Ortega Sara, Martín-Dominguez Verónica, Fernández-Pacheco Jennifer, Pérez-Fernández Maria Teresa, Ghisa Matteo, Maniero Daria, Nantes-Castillejo Óscar, Nicolay-Maneru Julia, Suárez Adolfo, Maray Iván, Llerena-Castro Ronald, Ortega-Larrodé Adriana, Alcedo Javier, Granja Navacerrada Alicia, Racca Francesca, Santander Cecilio, Arias Ángel, Lucendo Alfredo J, EUREOS and EoE CONNECT research group
Аннотация
OBJECTIVE: To assess the effectiveness of topical corticosteroid therapy for EoE in real-world practice.
METHODS: Cross-sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high-power field. The effectiveness in achieving clinico-histological remission (CHR) was compared for the main tC formulations.
RESULTS: Overall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first-line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8 mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4 mg/day provided no benefit over 2 mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p < 0.001); use of higher doses (OR 4.3, p = 0.03) and lower symptom scores (OR 0.9, p = 0.01) were also determinants of effectiveness.
CONCLUSION: Reduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.