Fable JM, et al. - Physicians performed this study to compare endoscopic and histologic outcomes after fluticasone propionate (FP) vs oral viscous budesonide (OVB) therapy in children with eosinophilic esophagitis (EoE) in their center. Compared to FP, treatment with OVB led to better endoscopic and histologic outcomes. Major determining factors in the response to treatments were adherence to treatment and history of asthma. Using Neocate Duocal or sucralose as the OVB delivery vehicle was found to be similarly effective.

Methods

• A retrospective chart review was performed of subjects diagnosed with EoE at a tertiary care center between 2010 and 2015.
• For this study, inclusion criteria were FP or OVB therapy for ≥8 weeks along with pre- and post-treatment endoscopic evaluation.
• The physicians recorded demographic and clinical features and endoscopic and histologic assessment for comparative analysis.
• They defined histologic response as <15 eos/hpf and remission as <5 eos/hpf.

Results

• A total of 68 EoE patients (20 FP and 48 OVB) with a mean age of 10.6 ± 5.2 years (range 1-20 years) were included; 81% were boys and 68% were Caucasian.
• The physicians found no significant demographic or clinical differences between the 2 study groups.
• In 44 of 68 (65%) patients, a histologic response to topical steroids was seen.
• A histologic response was achieved in significantly greater number of patients with OVB (36/48, 75%) than with FP (8/20, 40%) (P=0.0059).
• In the FP group, mean pretreatment peak eos/hpf was 46 ± 19 vs 45 ± 23 in the OVB group.
• Mean post-treatment peak eos/hpf in the FP group was 20 ± 29 vs 12 ± 16 in the OVB group (P=0.002).
• Moreover, there was a significantly greater difference in the change of absolute eos/hpf from pre- to post-treatment in the OVB group (-33) vs FP (18) (P=0.047).
• A histologic response was noted in a greater number of OVB-treated patients without asthma compared to those with asthma (P=0.031).
• As per outcomes, the response to OVB remained unaffected by the delivery vehicle, namely sucralose (Splenda) vs Neocate Duocal.