Steroids vs Dietary Therapy to Treat Eosinophilic Esophagitis
Steroids vs Dietary Therapy to Treat Eosinophilic Esophagitis
As mentioned, few studies have tried to identify differences in the effectiveness of EoE medications based on changes in their formulation or methods of drug delivery. Dellon et al. performed a randomized trial comparing nebulized and viscous topical steroid preparations in a cohort of adult patients. Patients received budesonide 1 mg twice daily, either in an aerosolized form swallowed from a nebulizer or as an oral viscous slurry, for a total of 8 weeks. Study endpoints included dysphagia improvement based on MDQ score, reduction in eosinophil counts, and mucosal medication contact time, which was measured by nuclear scintigraphy with tagged radiocontrast. The authors found that histologic improvement was significantly higher in the oral viscous budesonide group (64%) than in the swallowed nebulizer solution group (27%), although both groups had comparable improvement in their dysphagia scores. Nuclear scintigraphy showed that mucosal contact time was much higher in patients treated with the oral viscous budesonide than the nebulizer solution. This study showed that the frequency of histologic improvement may be directly related to mucosal contact time, and has highlighted the importance of appropriate drug delivery methods in treatment of this disease. It also shows that complete histologic resolution was achieved in only 64% of the oral viscous budesonide group, which is a lower percentage than has been found in prior studies.
Comparison of Different Formulations of Topical Corticosteroids
As mentioned, few studies have tried to identify differences in the effectiveness of EoE medications based on changes in their formulation or methods of drug delivery. Dellon et al. performed a randomized trial comparing nebulized and viscous topical steroid preparations in a cohort of adult patients. Patients received budesonide 1 mg twice daily, either in an aerosolized form swallowed from a nebulizer or as an oral viscous slurry, for a total of 8 weeks. Study endpoints included dysphagia improvement based on MDQ score, reduction in eosinophil counts, and mucosal medication contact time, which was measured by nuclear scintigraphy with tagged radiocontrast. The authors found that histologic improvement was significantly higher in the oral viscous budesonide group (64%) than in the swallowed nebulizer solution group (27%), although both groups had comparable improvement in their dysphagia scores. Nuclear scintigraphy showed that mucosal contact time was much higher in patients treated with the oral viscous budesonide than the nebulizer solution. This study showed that the frequency of histologic improvement may be directly related to mucosal contact time, and has highlighted the importance of appropriate drug delivery methods in treatment of this disease. It also shows that complete histologic resolution was achieved in only 64% of the oral viscous budesonide group, which is a lower percentage than has been found in prior studies.