A recent double-blind, double-dummy study (ES Dellon et al. Gastroenterol 2019; 157: 65-73) found similar efficacy between budesonide and fluticasone for newly-diagnosed eosinophilic esophagitis. They had hypothesized that an oral viscous budesonide would be more effective due to increased esophageal contact time.

Methods: The authors compared an oral viscous budesonide OVB) at 1 mg BID (n=56) to fluticasone (swallowed) MDI dosed at 880 mcg BID (n=55).  Patients aged 16-80 years, with mean of 37 years.

Baseline characteristics:

• ~95% in both groups with dysphagia
• ~75% with any atopic condition
• ~50% with dilatation required at baseline

Key findings:

• Similar drop in eosinophil count: 73 (OVB) and 77 (MDI) eos/hpf at baseline to 15 and 21 respectively
• Histologic response (<15 eos/hpf) rates of 71% (OVB) and 64% (MDI).
• Response to <5 eos/hpf occurred in 61% OVB and 49% MDI; response to <1 eos/hpf was noted in 41% and 35% respectively
• Symptom scores (DSQ) responded similarly as well
• Similar degree of candidiasis 12% for OVB and 16% for MDI

In the associated editorial, the authors speculate that one reason for similar efficacy was the detailed instructions given for patients taking the MDI.

My take: This study supports both topical steroid therapies; practical issues like cost and insurance coverage could be influential in selecting the specific treatment for an individual patient.

Related blog posts:

• Orodispensable Budesonide Tablets for Eosinophilic Esophagitis
• Surprising Findings in Prospective Study of Budesonide in EoE Study
• What Happens When Topical Steroids are Stopped in EoE
• Neglibible Effect of Eosinophilic Esophagitis Treatment on Longitudinal Growth
• What is EoE?
• EoE Update 2018 (Dr. Seth Marcus)
• Updated Consensus Guidelines for Eosinophilic Esophagitis
• A Better Budesonide for Eosinophilic Esophagitis
• A Better Budesonide for Eosinophilic Esophagitis (Part 2) | gutsandgrowth
• Dilatation for Eosinophilic Esophagitis -Pediatric Data | gutsandgrowth
• Adrenal Insufficiency due to Fluticasone in … – gutsandgrowth
• Higher Doses of Topical Steroids for Eosinophilic … – gutsandgrowth

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