Long-Term Treatment of Eosinophilic Esophagitis With Swallowed Topical Corticosteroids: Development and Evaluation of a Therapeutic Concept.

Details

Serval ID
serval:BIB_11CC3D5BA4DD
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Long-Term Treatment of Eosinophilic Esophagitis With Swallowed Topical Corticosteroids: Development and Evaluation of a Therapeutic Concept.
Journal
The American journal of gastroenterology
Author(s)
Greuter T., Bussmann C., Safroneeva E., Schoepfer A.M., Biedermann L., Vavricka S.R., Straumann A.
ISSN
1572-0241 (Electronic)
ISSN-L
0002-9270
Publication state
Published
Issued date
10/2017
Peer-reviewed
Oui
Volume
112
Number
10
Pages
1527-1535
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Swallowed topical corticosteroids (STCs) are efficacious in inducing and presumably maintaining remission in patients with active eosinophilic esophagitis (EoE). 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.
Since 2007, EoE patients included into a large database at the Swiss EoE Clinics were put on STCs 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. Data on all patients treated using this therapeutic strategy were analyzed retrospectively.
Of the 351 patients, 33 (9.4%) who were treated with STCs achieved deep remission. Median age of remitters at disease onset was 32.6 years (interquartile range (IQR) 19.1-49.3), and diagnostic delay was 5.4 years (IQR 1.2-11.4). Deep remission was achieved after 89.0 weeks (IQR 64.6-173.8). Female gender was the only independent prognostic factor for achieving deep remission (odds ratio (OR) 2.518, 95% confidence interval (CI) 1.203-5.269). Overall, STCs were stopped after 104.7 weeks (IQR 65.5-176.6). No mucosal damage was observed upon histological examination. In 27 of the 33 remitters (81.8%), a clinical relapse occurred after a median of 22.4 weeks (95% CI 5.1-39.7). Six remitters (18.2%) did not experience a clinical relapse during a follow-up of 35.1 weeks (IQR 18.3-44.9). Hence, a total of 1.7% (6/351) patients were able to discontinue STCs in the long term.
Long-term EoE treatment with STCs 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.

Keywords
Administration, Oral, Adult, Databases, Factual, Drug Monitoring/methods, Eosinophilic Esophagitis/diagnosis, Eosinophilic Esophagitis/drug therapy, Eosinophilic Esophagitis/epidemiology, Esophagoscopy/methods, Female, Follow-Up Studies, Glucocorticoids/administration & dosage, Glucocorticoids/adverse effects, Humans, Long Term Adverse Effects/diagnosis, Long Term Adverse Effects/epidemiology, Long Term Adverse Effects/etiology, Long-Term Care/methods, Long-Term Care/statistics & numerical data, Maintenance Chemotherapy/methods, Male, Middle Aged, Patient Acuity, Prognosis, Recurrence, Remission Induction/methods, Sex Factors, Switzerland/epidemiology
Pubmed
Web of science
Create date
09/08/2017 15:20
Last modification date
20/08/2019 12:39
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