PURPOSE OF THE STUDY.
Oral topical steroid therapies with oral viscous budesonide or fluticasone propionate are effective treatment options for eosinophilic esophagitis (EoE) patients, but a comparison between the 2 treatments has not been performed in pediatric patients. This study was designed to compare these 2 treatments.
A total of 68 EoE patients from Connecticut Children’s Medical Center seen from 2010 to 2015.
A retrospective chart review of patients all treated with either swallowed fluticasone propionate or oral viscous budesonide (thickened with either Neocate Duocal or sucralose) for >8 weeks who underwent endoscopy pre- and posttreatment.
Two-thirds cohort responded to topical steroids (65%), with fewer responding to fluticasone (FP) than oral viscous budesonide (OVB) (40% vs 75%, P < .006). Lower posttreatment eosinophils per high-power field (eos/HPF) levels were noted in the OVB treated patients (12±16 eos/HPF) compared with the FP treated group (20±29 eos/HPF). There was also a significantly greater difference in the change of absolute eos/HPF from pre- to posttreatment in the OVB group versus FP (−33 vs −18, P = .047). Asthma was associated with a poorer response in OVB treated patients. The vehicle thickener did not affect outcomes.
The data suggest that treatment with oral viscous budesonide leads to better endoscopic and histologic outcomes than fluticasone. Adherence to treatment and history of asthma are major determining factors in the response to treatments. Using Neocate Duocal as the budesonide delivery vehicle is just as effective as sucralose.
This is the first study to directly compare the efficacy of topical steroid therapies in EoE. The limitations of this study include the retrospective nature and the potential selection bias, as the patients included in the study were treated based on provider preference, a past history of treatment success or failure, patient preference, insurance issues, or other reasons that could impact the measured response rates. In addition, the compliance with treatment was not assessed.
- Copyright © 2017 by the American Academy of Pediatrics