Long-term treatment of eosinophilic esophagitis esophagitis with budesonide


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Long-term treatment of eosinophilic esophagitis esophagitis with budesonide
Titre de la conférence
Digestive Disease Week (DDW) 2010
Straumann A., Degen L., Bussmann C., Beglinger C., Schoepfer A., Thalmann C., Simon H.U.
New Orleans, Louisiana, United-States, May 1-5, 2010
Statut éditorial
Date de publication
BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic-inflammatory disease of the
esophagus, characterized by esophagus-related symptoms and a dense tissue eosinophilia,
both refractory to proton pump inhibitors. Topical corticosteroids have proven effective in
inducing clinical and histologic remission. However, a long-term strategy for the management
of this chronic disease is not yet defined.
METHODS: In a randomized, double-blind, placebocontrolled,
long-term trial, we evaluated the efficacy of twice-daily 0.25 mg swallowed
budesonide in maintaining a remission in adult EoE with prior response to induction therapy.
Pre- and post-treatment disease activity was assessed clinically, endoscopically, histologically,
by immunofluorescence and by high-resolution endosonography. The primary end point
was the ability to maintain histologic remission (<5 eos/hpf) of EoE in. Secondary end points
were the efficacy on symptom control and on tissue remodeling as well as the determination
of the safety of long-term esophageal administration of topical corticosteroids.
RESULTS: During a 50-week therapy of quiescent EoE with low-dose budesonide the esophageal
eosinophil load (ECP staining) increased from 1.1 to 29.9 eos/hpf, but under placebo the
increase was significantly larger (0.5 to 51.1 eos/hpf; p=0.01). At the end of the studyperiod,
35.7% (5/14) of the budesonide patients were in complete and 14.3% (2/14) in
partial histologic remission; with placebo no patient was in complete and 28.6% (4/14)
were in partial remission (p=0.0647). The increase of the symptom score was markedly
lower in budesonide- (0.79 to 2.29 points) than in placebo-patients (0.71 to 4.00 points;
p=0.0875). The median time to relapse of symptoms was >125 days in the budesonide and
95 days in the placebo group (p = 0.14). Measured by high-resolution endosonography, all
EoE patients had pre-treatment a highly thickened esophageal wall compared with healthy
controls (3.05±1.08 mm vs. 2.18±0.35 mm; p<0.0001). Long-term topical budesonide
reduced mainly the thickness of the superficial wall layers (mucosa, 0.75 mm to 0.45 mm;
p=0.025) whereas the response of the deeper layers was less pronounced (submucosa 1.31
to 1.08 mm; p=0.19 and muscularis 0.82 to 0.76 mm; p=0.72). Budesonide did not evoke
any mucosal atrophy.
CONCLUSIONS: This study clearly demonstrates that 1) Untreated
eosinophil inflammation results in an impressive remodeling of the esophagus; 2) A therapy
is therefore needed; 3) The high relapse rate after short-term therapy requires a long-term
management and 4) Maintenance treatment with budesonide is well tolerated and keeps
half of the patients in remission.
Création de la notice
02/02/2011 15:05
Dernière modification de la notice
03/03/2018 18:42
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