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- Title
Comparisons of Fluticasone to Budesonide in the Treatment of Eosinophilic Esophagitis.
- Authors
Albert, Dustin; Heifert, Theresa; Min, Steve; Maydonovitch, Corinne; Baker, Thomas; Chen, Yen-Ju; Moawad, Fouad; Heifert, Theresa A; Min, Steve B; Maydonovitch, Corinne L; Baker, Thomas P; Moawad, Fouad J
- Abstract
<bold>Background: </bold>Topical steroids are first-line treatment agents for eosinophilic esophagitis; however, some studies have demonstrated modest efficacy in inducing histologic remission.<bold>Aims: </bold>The aim of this study was to determine response to two topical steroids (fluticasone and budesonide), compare their efficacy, and examine patient characteristics which could predict non-response to topical steroids.<bold>Methods: </bold>We performed a retrospective review of an established EoE registry. Inclusion criteria were patients >1 year of age who were diagnosed with EoE as defined by the most recent consensus guidelines. All patients were treated with an 8-week course of either swallowed fluticasone or viscous budesonide. Responders were defined as achieving <15 eosinophils per high-power field (eos/hpf) in both proximal and distal esophageal biopsies. Demographic, clinical, endoscopic, and histologic features were examined.<bold>Results: </bold>The study cohort included 75 EoE patients with a median age of 33 years (range 2-64 years), 71 % adults, 84 % male, and 76 % Caucasian. Overall histologic response rate to topical steroids was 51 %, while clinical response was 71 %. There was no significant differences in histologic response to treatment between children and adults (68 vs. 44 %, p = 0.111). There was no significant difference in response between males and females (47 vs. 73 %, p = 0.191) and between the two types of steroids (48 vs. 56 %, p = 0.632). Responders and non-responders were similar in clinical presentation and baseline endoscopic findings. Following treatment, responders had significantly less peak proximal (4.0 ± 4.4 vs. 46 ± 53, p < 0.001) and distal eosinophil counts (3.5 ± 3.8 vs. 60 ± 47, p < 0.001) compared to non-responders. There were no predictors of response to steroids identified.<bold>Conclusions: </bold>Histologic response to treatment was observed in approximately half the cohort, while more than two-thirds experienced clinical response to topical steroids. Response was similar between fluticasone and budesonide. Given the lack of differences in clinical presentation or endoscopic features, predictors of non-response were not seen.
- Subjects
FLUTICASONE; BUDESONIDE; EOSINOPHILIC esophagitis; STEROID drugs; EOSINOPHILS; THERAPEUTICS; ANTI-inflammatory agents; RETROSPECTIVE studies
- Publication
Digestive Diseases & Sciences, 2016, Vol 61, Issue 7, p1996
- ISSN
0163-2116
- Publication type
journal article
- DOI
10.1007/s10620-016-4110-9