EoE Module 10 References-Dellon et al Gasteroenterology 2019 Efficacy of budesonide vs fluticasone for initial treatment of EoE in a RCT

Dellon et al Gasteroenterology 2019 Efficacy of budesonide vs fluticasone for initial treatment of EoE in a RCT

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The study compares the efficacy of two topical steroid treatments for patients with Eosinophilic Esophagitis (EoE) who did not respond to proton pump inhibitors: oral viscous budesonide (OVB) and fluticasone from a multi-dose inhaler (MDI). This randomized, double-blind, double-dummy trial included 129 newly diagnosed EoE patients, split into two groups. They each received either OVB with a placebo inhaler or MDI with a placebo slurry for 8 weeks.<br /><br />Primary outcomes included post-treatment eosinophil counts and dysphagia scores, while secondary outcomes focused on endoscopic severity, histologic response, and safety. Results showed both treatments significantly reduced eosinophil counts and improved symptoms, but OVB did not prove to be superior to fluticasone MDI. Histologic responses were similar: 71% in the OVB group and 64% in the MDI group met the response threshold (15 eos/hpf).<br /><br />Both medications were generally well-tolerated, with some cases of esophageal and oral candidiasis reported. Patients who responded to treatment were somewhat younger and showed certain characteristics, such as a lower body mass index and more frequent eczema.<br /><br />The study concluded that both OVB and fluticasone MDI are viable initial treatments for EoE, recommending that patient preference, ease of use, and cost considerations guide the choice between the two. The trial was robust, including validated metrics and a sizable sample, although it was conducted at a single center with potentially less generalizable results given the particular characteristics of the cohort, such as a high prevalence of strictures needing dilation.

Keywords

Eosinophilic Esophagitis

topical steroid treatments

oral viscous budesonide

fluticasone inhaler

randomized trial

eosinophil counts

dysphagia scores

histologic response

esophageal candidiasis

treatment efficacy