Schupack Daniel A, Johnson Kimberly, Akambase Joseph A, Geno Debra, Lavey Crystal, Lennon Ryan J, Ravi Karthik, Snyder Diana L, Katzka David A, Alexander Jeffrey A
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Division of Pulmonary Medicine, Mayo Clinic, Rochester, MN, USA.
Dis Esophagus. 2022 Dec 31;36(1). doi: 10.1093/dote/doac040.
Topical steroids are commonly used in treatment of eosinophilic esophagitis (EoE), but currently there is lack of data to clarify most effective regimen. We aimed to study the achievement of histologic remission using the same dose of budesonide in two different delivery formulations. Patients with established EoE treated with pharmacy compounded budesonide capsule or budesonide Rincinol gel (both 3 mg twice daily) were studied retrospectively. Those with pre-treatment and post-treatment histologic assessment were included with main endpoint being histologic remission. 103 patients (62 gel, 41 capsule) were included, with higher rate of histologic remission with gel (84 vs. 59%, P=0.004). A subset of patients in both groups had lack of steroid response (<50% drop in eosinophils) (15% for gel, 32% for capsule). Formulation/delivery vehicle of steroid treatments to esophageal mucosa in EoE appears important for treatment efficacy, with budesonide gel having higher likelihood of histologic remission compared to budesonide capsules in our population. A truly steroid refractory group appears likely in our population. Larger, prospective studies may help clarify best regimen of topical steroids in EoE and may work to identify patients likely to benefit from alternative therapies.
局部用类固醇常用于嗜酸性粒细胞性食管炎（EoE）的治疗，但目前缺乏数据来阐明最有效的治疗方案。我们旨在研究使用相同剂量的布地奈德的两种不同给药制剂实现组织学缓解的情况。对接受药房配制的布地奈德胶囊或布地奈德Rincinol凝胶（均为每日两次，每次3毫克）治疗的确诊EoE患者进行回顾性研究。纳入有治疗前和治疗后组织学评估的患者，主要终点为组织学缓解。共纳入103例患者（62例使用凝胶，41例使用胶囊），凝胶组的组织学缓解率更高（84%对59%，P = 0.004）。两组中都有一部分患者对类固醇无反应（嗜酸性粒细胞减少<50%）（凝胶组为15%，胶囊组为32%）。在EoE中，类固醇治疗对食管黏膜的制剂/给药载体似乎对治疗效果很重要，在我们的研究人群中，与布地奈德胶囊相比，布地奈德凝胶实现组织学缓解的可能性更高。在我们的研究人群中似乎存在一个真正对类固醇难治的群体。规模更大的前瞻性研究可能有助于阐明EoE中局部用类固醇的最佳治疗方案，并可能有助于识别可能从替代疗法中获益的患者。
