Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2024
Clinical, Histologic, and Safety Outcomes With Long-term Maintenance Therapies for Eosinophilic Esophagitis: A Systematic Review and Meta-analysis.
СтатьяСистематический обзорМетаанализНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Barchi Alberto, Massimino Luca, Mandarino Francesco Vito, Yacoub Mona-Rita, Albarello Luca, Savarino Edoardo Vincenzo, Ungaro Federica, Danese Silvio, Passaretti Sandro, Bredenoord Albert J, Vespa Edoardo
Аннотация
BACKGROUND & AIMS: Our aim was to evaluate the outcomes of maintenance treatments for eosinophilic esophagitis (EoE) among observational studies (OSs) and randomized controlled trials (RCTs).
MATERIALS AND METHODS: Studies reporting histologic success of maintenance therapy ≥48 weeks were included. The primary outcome was histologic success rate (defined as <15/<6 eosinophils/high-power field). Risk ratios (RRs) for histologic success of maintenance therapy vs placebo or induction and drug safety were also assessed. Random effects meta-analyses with heterogeneity measured with I2 were performed. RCTs and OSs were analyzed separately.
RESULTS: In RCTs, histologic <15 eosinophils/high-power field rates were 86% (95% confidence interval [CI], 71%-96%) for corticosteroids and 79% (95% CI, 69%-87%) for biologics. Dupilumab alone accounted for 82% (95% CI, 72%-89%), whereas small molecules yielded 28%. Biologics showed higher <6 eosinophils/high-power field rates compared with corticosteroids (70% vs 59%). Clinical success was 58% (95% CI, 31%-83%) for corticosteroids and 59% (95% CI, 34%-82%) for biologics. Budesonide showed common-effect adjusted RR of 7.87 (95% CI, 4.19-14.77) of maintaining histologic remission over therapy discontinuation. In OSs, proton pump inhibitors showed 64% (95% CI, 43%-83%) histologic and 80% (95% CI, 53%-97%) clinical success, whereas corticosteroids achieved 49% (95% CI, 30%-68%) and 51% (95% CI, 18%-83%) rates, respectively. Therapy de-escalation was not associated with histologic relapse (RR, 1.04; 95% CI, 0.72-1.51). Long-term safety was confirmed with 3% (95% CI, 1%-6%) severe adverse events in RCTs and 5% (95% CI, 2%-9%) in OSs. Treatment withdrawal rates were low (10% for RCTs, 4% for OSs). Moderate to substantial heterogeneity was observed for most outcomes.
CONCLUSIONS: Maintenance therapies prevent histologic relapse in the long term, without clear disadvantage of dose de-escalation from induction to maintenance phase. Low adverse events and withdrawal rates confirm long-term treatment is well-tolerated.
MATERIALS AND METHODS: Studies reporting histologic success of maintenance therapy ≥48 weeks were included. The primary outcome was histologic success rate (defined as <15/<6 eosinophils/high-power field). Risk ratios (RRs) for histologic success of maintenance therapy vs placebo or induction and drug safety were also assessed. Random effects meta-analyses with heterogeneity measured with I2 were performed. RCTs and OSs were analyzed separately.
RESULTS: In RCTs, histologic <15 eosinophils/high-power field rates were 86% (95% confidence interval [CI], 71%-96%) for corticosteroids and 79% (95% CI, 69%-87%) for biologics. Dupilumab alone accounted for 82% (95% CI, 72%-89%), whereas small molecules yielded 28%. Biologics showed higher <6 eosinophils/high-power field rates compared with corticosteroids (70% vs 59%). Clinical success was 58% (95% CI, 31%-83%) for corticosteroids and 59% (95% CI, 34%-82%) for biologics. Budesonide showed common-effect adjusted RR of 7.87 (95% CI, 4.19-14.77) of maintaining histologic remission over therapy discontinuation. In OSs, proton pump inhibitors showed 64% (95% CI, 43%-83%) histologic and 80% (95% CI, 53%-97%) clinical success, whereas corticosteroids achieved 49% (95% CI, 30%-68%) and 51% (95% CI, 18%-83%) rates, respectively. Therapy de-escalation was not associated with histologic relapse (RR, 1.04; 95% CI, 0.72-1.51). Long-term safety was confirmed with 3% (95% CI, 1%-6%) severe adverse events in RCTs and 5% (95% CI, 2%-9%) in OSs. Treatment withdrawal rates were low (10% for RCTs, 4% for OSs). Moderate to substantial heterogeneity was observed for most outcomes.
CONCLUSIONS: Maintenance therapies prevent histologic relapse in the long term, without clear disadvantage of dose de-escalation from induction to maintenance phase. Low adverse events and withdrawal rates confirm long-term treatment is well-tolerated.