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TOPLINE:

A twice-daily dose of a proton pump inhibitor (PPI) leads to higher histologic response rates in patients with eosinophilic esophagitis (EoE) than a once-daily dose, even if the total daily dosage remains the same.

METHODOLOGY:

• Because the optimal PPI regimen for EoE is unclear, researchers conducted a retrospective cohort study to determine the dosing strategy that is best able to induce histologic remission in patients with the disease.
• They recruited 305 adult patients (54.6% men; mean age, 44.7 years) with newly diagnosed, treatment-naive EoE who received PPI (omeprazole) at a standard (once-daily 20 mg), moderate (once-daily 40 mg or twice-daily 20 mg), or high (twice-daily 40 mg) dose for ≥ 8 weeks.
• All study participants underwent repeat endoscopy 8-12 weeks after PPI initiation.
• The primary outcome was a histologic response to PPI, defined as fewer than 15 eosinophils/hpf on repeat esophageal biopsies.

TAKEAWAY:

• Overall, 42.3% of the patients exhibited a histologic response to PPI.
• In the moderate-dose group, the histologic response rate was higher with the twice-daily 20 mg PPI dose than the once-daily 40 mg PPI dose (52.8% vs 10%; P < .0001).
• Compared with the standard PPI dose, higher histologic response rates were associated with the twice-daily moderate dose (adjusted odds ratio [aOR], 6.75; P = .0008) and the high dose (aOR, 12.8; P < .0001), but not the once-daily moderate dose.
• Histologic response rates were comparable between the once-daily moderate and standard PPI doses (P = .81) and between twice-daily moderate and high PPI doses (P = .82).

IN PRACTICE:

"Twice-daily PPI is likely more effective than once-daily PPI in inducing histologic remission in EoE, even when the total daily dose is equivalent. The optimal PPI regimen for induction of histologic remission in EoE is likely moderate twice-daily dosing (20 mg of omeprazole twice daily) because high-dose PPI (40 mg twice daily) does not seem to provide additional benefit," the authors wrote.

SOURCE:

The study, led by Mayssan Muftah, MD, MPH, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts, was published online in The American Journal of Gastroenterology.

LIMITATIONS:

The retrospective design of the study is a major limitation in that the compliance to the various regimens could not be ascertained.

DISCLOSURES:

This study had no funding to report. One of the authors served on scientific advisory boards for Sanofi Pharmaceuticals and Regeneron Pharmaceuticals.