T Greuter et al. Clin Gastroenterol Hepatol 2021; 19: 2514-2523. Open Access: Effectiveness and Safety of High- vs Low-Dose Swallowed Topical Steroids for Maintenance Treatment of Eosinophilic Esophagitis: A Multicenter Observational Study
In this multicenter, retrospective study with 82 participants (mean age 37 years), the authors examined swallowed topical corticosteroids (STC) for maintenance of histologic remission (<15 eos/hpf). Low dose STC (22 budesonide, 60 fluticasone) was considered 0.5 mg/day or less. Key findings:
- Histological relapse occurred in 67% of patients. This rate was comparable in patients treated with low-dose (72%) and high-dose (54%) STCs.
- Histological relapse occurred significantly earlier with low dose STC (1.0 vs 1.8 years, P = .030)
- Esophageal candidiasis was identified in 6% of subjects
The authors conclude that most of the histological relapse that occurred was due to true steroid failure since “low adherence and treatment cessation during follow-up were exclusion criteria.” Also, they note that “the recently finished but not yet fully published Maintenance of Remission With Budesonide Orodispersible Tablets vs Placebo in Eosinophilic Eosphagitis (EOS2 trial) (NCT02493335) comparing budesonide maintenance doses of 2 mg/d vs 1 mg/d suggest that there is no additional benefit of daily doses higher than 1 mg (1-year remission rates of 75.0% and 73.5%, respectively).
My take: Low dose STCs do not appear to be as effective in maintaining histologic remission; however, there is a high rate of relapse even in those with higher doses.
Related blog posts:
- What Happens When Topical Steroids Are Stopped in Eosinophilic Esophagitis
- Budesonide for Maintaining EoE Remission | gutsandgrowth
- Head-to-Head: Budesonide vs Fluticasone for Eosinophilic Esophagitis
- Lingering Histologic Changes with Eosinophilic Esophagitis in Remission, Plus One | gutsandgrowth
- Expecting Change in Eosinophilic Esophagitis Treatment | gutsandgrowth
- New 2020 Eosinophilic Esophagitis Guidelines | gutsandgrowth
- Surprising Findings in Prospective Budesonide-Eosinophilic Esophagitis Study
- Orodispensable Budesonide Tablets for Eosinophilic Esophagitis | gutsandgrowth
- Genetic Basis of Eosinophilic Esophagitis | gutsandgrowth
- Eosinophilic Esophagitis -Up to Date Dietary Management Review | gutsandgrowth
- EoE Update 2018 (Dr. Seth Marcus)
- Updated Consensus Guidelines for Eosinophilic Esophagitis