Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Department of Internal Medicine, GZO - Zurich Regional Health Center, Wetzikon, Switzerland; Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Department of Internal Medicine, GZO - Zurich Regional Health Center, Wetzikon, Switzerland.
Clin Gastroenterol Hepatol. 2021 Dec;19(12):2514-2523.e2. doi: 10.1016/j.cgh.2020.08.027. Epub 2020 Aug 13.
BACKGROUND & AIMS: Data evaluating efficacy of different doses of swallowed topical corticosteroids (STC) in the long-term management of eosinophilic esophagitis (EoE) are lacking. We assessed long-term effectiveness and safety of different STC doses for adults with EoE after achievement of histological remission.
We performed a retrospective multicenter study at five EoE referral centers (US and Switzerland). We analyzed data on 82 patients with EoE in histological remission and ongoing STC treatment with therapeutic adherence of ≥75% (58 males; mean age at diagnosis, 37.2±14.4 years). Patients were followed for a median of 2.2 years (interquartile range [IQR], 1.0-3.8 years). We collected data from 217 follow-up endoscopy visits. The primary endpoint was time to histological relapse.
Histological relapse occurred in 67% of patients. Relapse rates were comparable in patients taking low dose (≤0.5 mg per day, n = 58) and high dose STC (>0.5 mg per day, n = 24) with 72 vs 54% (ns). However, histological relapse occurred significantly earlier with low dose STC (1.0 vs 1.8 years, P = .030). There was no difference regarding rates of and time to stricture formation for low vs high dose STC. Esophageal candidiasis was observed in 6% of patients (5% for low dose, 8% for high dose, ns). No dysplasia or mucosal atrophy was detected.
Histological relapse frequently occurs in EoE despite ongoing STC treatment regardless of STC doses. However, relapse develops later in patients on high dose STC without an increase in side-effects. Doses higher than 0.5 mg/day may be considered for EoE maintenance treatment, but advantage over lower doses appears to be small.
缺乏评估不同剂量吞咽局部皮质类固醇（STC）在嗜酸细胞性食管炎（EoE）长期管理中的疗效的数据。我们评估了达到组织学缓解后，不同剂量 STC 对 EoE 成人患者的长期疗效和安全性。
我们在五家 EoE 转诊中心（美国和瑞士）进行了一项回顾性多中心研究。我们分析了 82 例组织学缓解且持续接受 STC 治疗（治疗依从性≥75%）的 EoE 患者的数据（58 名男性；诊断时的平均年龄为 37.2±14.4 岁）。患者的中位随访时间为 2.2 年（四分位距 [IQR]，1.0-3.8 年）。我们从 217 次随访内镜检查中收集数据。主要终点是组织学复发时间。
67%的患者发生组织学复发。接受低剂量（≤0.5mg/天，n=58）和高剂量 STC（>0.5mg/天，n=24）的患者复发率相当，分别为 72%和 54%（无统计学意义）。然而，低剂量 STC 发生组织学复发的时间明显更早（1.0 年 vs 1.8 年，P=0.030）。低剂量和高剂量 STC 之间的狭窄形成率和时间无差异。6%的患者出现食管念珠菌病（低剂量组为 5%，高剂量组为 8%，无统计学意义）。未发现异型增生或黏膜萎缩。
尽管持续接受 STC 治疗，但 EoE 患者仍经常发生组织学复发，而与 STC 剂量无关。然而，高剂量 STC 治疗的患者复发时间较晚，且副作用没有增加。对于 EoE 的维持治疗，可能需要考虑高于 0.5mg/天的剂量，但与较低剂量相比，优势似乎较小。
