학술논문
Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real-world efficacy from the EoE CONNECT registry.
Document Type
Academic Journal
Author
Laserna-Mendieta EJ; Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.; Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Madrid, Spain.; Laboratory Medicine Department, Hospital Universitario de La Princesa, Madrid, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.; Navarro P; Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.; Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Madrid, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.; Casabona-Francés S; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.; Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain.; Savarino EV; Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.; Gastroenterology Unit, Azienza Ospedaliera di Padova, Padova, Italy.; Amorena E; Department of Gastroenterology, Hospital Universitario de Navarra, Pamplona, Spain.; Pérez-Martínez I; Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain.; Diet, Microbiota and Health Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.; Guagnozzi D; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.; Department of Gastroenterology, Hospital Universitario Valld'Hebrón, Barcelona, Spain.; Blas-Jhon L; Department of Gastroenterology, Fundación Jiménez Díaz, Madrid, Spain.; Betoré E; Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain.; Guardiola-Arévalo A; Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain.; Pellegatta G; Endoscopic Unit, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Milan, Italy.; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.; Krarup AL; Department of Emergency Medicine and Trauma Care, Aalborg University Hospital, Aalborg, Denmark.; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.; Perello A; Department of Gastroenterology, Hospital de Viladecans, Viladecans, Spain.; Barrio J; Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain.; Gutiérrez-Junquera C; Pediatric Gastroenterology Unit, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Madrid, Spain.; Teruel Sánchez-Vegazo C; Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Fernández-Fernández S; Department of Pediatric Gastroenterology, Hospital Universitario Severo Ochoa, Leganés, Spain.; Naves JE; Department of Gastroenterology, Parc de Salut Mar, Barcelona, Spain.; Oliva S; Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza - University of Rome, Rome, Italy.; Rodríguez-Oballe JA; Department of Gastroenterology, Hospital Universitario Arnau de Vilanova & Hospital Universitario Santa María, Lérida, Spain.; Carrión S; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.; Department of Gastroenterology, Hospital de Mataró, Mataró, Spain.; Espina S; Department of Gastroenterology, Hospital General de la Defensa, Zaragoza, Spain.; Llorente Barrio M; Department of Gastroenterology, Hospital de Santa Bárbara, Soria, Spain.; Masiques-Mas ML; Department of Pediatric Gastroenterology, Hospital de Granollers, Granollers, Spain.; Dainese R; Department of Gastroenterology, Centre Hospitalier d'Antibes Juan-les-Pins, Antibes, France.; Feo-Ortega S; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.; Department of Pediatrics, Hospital General de Tomelloso, Tomelloso, Spain.; Martín-Dominguez V; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.; Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain.; Fernández-Pacheco J; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.; Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain.; Pérez-Fernández MT; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.; Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain.; Ghisa M; Gastroenterology Unit, Azienza Ospedaliera di Padova, Padova, Italy.; Maniero D; Gastroenterology Unit, Azienza Ospedaliera di Padova, Padova, Italy.; Nantes-Castillejo Ó; Department of Gastroenterology, Hospital Universitario de Navarra, Pamplona, Spain.; Nicolay-Maneru J; Department of Gastroenterology, Hospital Universitario de Navarra, Pamplona, Spain.; Suárez A; Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain.; Diet, Microbiota and Health Group, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain.; Maray I; Department of Pharmacy, Hospital Universitario Central de Asturias, Oviedo, Spain.; Llerena-Castro R; Department of Gastroenterology, Hospital Universitario Valld'Hebrón, Barcelona, Spain.; Ortega-Larrodé A; Department of Gastroenterology, Fundación Jiménez Díaz, Madrid, Spain.; Alcedo J; Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain.; Granja Navacerrada A; Department of Gastroenterology, Hospital Universitario de Fuenlabrada, Fuenlabrada, Spain.; Racca F; Personalized Medicine, Asthma and Allergy Clinic, IRCCS Humanitas Research Hospital, Rozzano, Italy.; Santander C; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.; Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain.; Arias Á; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.; Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Madrid, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.; Research Unit, Hospital General Mancha-Centro, Alcázar de San Juan, Spain.; Lucendo AJ; Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.; Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Madrid, Spain.; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Instituto de Salud Carlos III, Madrid, Spain.
Source
Publisher: Wiley Country of Publication: England NLM ID: 101606807 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2050-6414 (Electronic) Linking ISSN: 20506406 NLM ISO Abbreviation: United European Gastroenterol J Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Swallowed topical corticosteroids (tC) are common therapy for patients with eosinophilic esophagitis (EoE). Widely heterogeneous results have occurred due to their active ingredients, formulations and doses.
Objective: To assess the effectiveness of topical corticosteroid therapy for EoE in real-world practice.
Methods: Cross-sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high-power field. The effectiveness in achieving clinico-histological remission (CHR) was compared for the main tC formulations.
Results: Overall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first-line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8 mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4 mg/day provided no benefit over 2 mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p < 0.001); use of higher doses (OR 4.3, p = 0.03) and lower symptom scores (OR 0.9, p = 0.01) were also determinants of effectiveness.
Conclusion: Reduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.
(© 2024 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)
Objective: To assess the effectiveness of topical corticosteroid therapy for EoE in real-world practice.
Methods: Cross-sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high-power field. The effectiveness in achieving clinico-histological remission (CHR) was compared for the main tC formulations.
Results: Overall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first-line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8 mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4 mg/day provided no benefit over 2 mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p < 0.001); use of higher doses (OR 4.3, p = 0.03) and lower symptom scores (OR 0.9, p = 0.01) were also determinants of effectiveness.
Conclusion: Reduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.
(© 2024 The Authors. United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)