TOPLINE

Patients with eosinophilic esophagitis (EoE) who switched from budesonide viscous solution (BVS) to budesonide orodispersible tablets (BOT) at the same dose and schedule experienced significant improvements in histological and deep histological remission rates. Endoscopic scores also improved significantly, and health-related quality of life (HRQOL) increased, though a numeric rise in endoscopic suspicion of candidiasis was observed.

METHODOLOGY

• Researchers conducted a retrospective analysis of a prospectively collected dataset including 45 adult patients with EoE who switched from BVS to BOT at the same dose (1 mg) and dosing schedule (32 patients switched in a once-daily [OD] schedule; 13 in a twice-daily schedule) at University Hospitals Leuven, Belgium.
• Patients had been on BVS therapy for a median of 440 days (OD group) or 112 days (twice-daily group) before switching to BOT.
• Patients on BVS maintenance therapy were evaluated before and after switching to BOT, with endoscopy and questionnaires repeated at a median of 170 days and 80 days after the switch in the OD and twice-daily group, respectively.
• Histological remission was defined as fewer than 15 eosinophils per high-power field (eos/HPF), and deep histological remission as fewer than 6 eos/HPF; endoscopic remission was defined as an endoscopic reference score (EREFS) of 2 or less.
• Symptom severity was assessed using the dysphagia symptom questionnaire, eosinophilic esophagitis symptom activity index, and numerical rating scale; HRQOL was measured with the adult EoE quality of life questionnaire (EoE-QoL-A).

TAKEAWAY

• Among patients switching to BOT 1 mg OD, the proportion achieving histological remission increased from 78.1% to 96.9% (P = .04), and deep histological remission rose from 71.9% to 96.9% (P = .01), with a decrease in peak eosinophil counts (P = .003).
• Endoscopic remission was achieved by all patients switching to BOT 1 mg OD from BVS (90.6%; P = .08); total EREFS improved from 1 to 0 (P = .003) along with a significant decrease in the inflammatory subscore (P = .002).
• For patients switching to BOT 1 mg twice daily, histological remission increased from 61.5% to nearly all patients (P = .03), deep histological remission rose from 46.2% to the full group (P = .008), and peak eosinophil counts fell from 6 to 0 eos/HPF (P = .02).
• HRQOL improved significantly in the OD group, with EoE-QoL-A scores rising from 79 to 87 (P = .008), while symptom severity scores remained low across both groups.

IN PRACTICE

"BOT may be a potential rescue option in patients who fail BVS therapy, prior to escalation of (biological) treatment strategies," wrote the authors of the study.

SOURCE

The study was led by Jana Defrancq, Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium. It was published online on July 17 in Therapeutic Advances in Gastroenterology.

LIMITATIONS

Selection bias may have been introduced, as patients were already responding to BVS therapy and those with compliance below 80% were excluded. Treatment durations differed between OD and twice-daily therapies, precluding direct comparisons. Online questionnaires were not completed by all patients, and adverse events other than candidiasis were not systematically assessed.

DISCLOSURES

The study was supported by grants from Flanders Research Foundation and a Methusalem grant of KU Leuven. Some of the authors reported receiving lecturing fees, consulting fees, or research grants from Dr Falk Pharma. Additional author disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.