TOPLINE:

Among swallowed topical corticosteroids for eosinophilic oesophagitis (EoE), budesonide and fluticasone orodispersible tablets showed superior histologic efficacy, and budesonide inhalation devices and viscous suspension were better for symptom relief and endoscopic improvement, respectively.

METHODOLOGY:

• Researchers conducted a systematic review and network meta-analysis of 22 phase 2 and phase 3 randomised controlled trials to compare the efficacy of different swallowed topical corticosteroid formulations in inducing and maintaining clinical and histologic remission in patients with active EoE.
• This study involved 1687 participants from 10 different countries, with 1455 patients with active EoE assessed for the induction of remission (19 studies) and 232 patients with inactive EoE analysed for the maintenance of long-term remission (three studies) using swallowed topical corticosteroids.
• The intervention included any topical corticosteroid, such as budesonide, fluticasone, or mometasone, with the comparison including different modalities of administration; treatment was compared with or without a placebo or proton pump inhibitors or oral prednisone.
• Interventions to induce EoE remission lasted 2-14 weeks, and interventions to maintain remission lasted 36-50 weeks.
• Outcomes included histologic remission at multiple thresholds (a peak eosinophil count [PEC] of < 15-20, < 5-6, and < 1 eosinophil per high-power field [eos per hpf]), endoscopic or symptomatic improvement, and adverse events.

TAKEAWAY:

• Budesonide orodispersible tablets yielded superior efficacy in achieving histologic remission at each threshold than comparators: a PEC < 15-20 eos per hpf (risk ratio [RR], 0.01; 95% CI, < 0.01-0.08), a PEC < 5-6 eos per hpf (RR, < 0.01; 95% CI, < 0.01-0.02), or a PEC < 1 eos per hpf (RR, < 0.01; 95% CI, < 0.01-0.15).
• Orodispersible tablets and inhalation for fluticasone and budesonide viscous suspension were also superior to comparators for histologic remission.
• Budesonide inhalers significantly improved symptoms compared with placebo or other corticosteroids, and only budesonide viscous suspension improved endoscopic findings compared with placebo (mean difference, -3.09; 95% CI, -5.10 to -1.07).
• No significant associations were found between any active ingredient, administration methods, or their combinations and the risk for adverse events.

IN PRACTICE:

"This NMA [network meta-analysis] supports the efficacy of budesonide and fluticasone over placebo for inducing the histological remission of EoE independently of the formulation used to administer the drug," the authors of the study wrote.

SOURCE:

This study was led by Alfredo J. Lucendo, Hospital General de Tomelloso, Tomelloso, Spain. It was published online on November 04, 2025, in the Journal of Clinical Medicine.

LIMITATIONS:

Trials spanning two decades may have introduced substantial heterogeneity in histologic assessment. Symptom outcomes were measured inconsistently across studies, and all budesonide formulations were pooled despite variable doses (1-4 mg/d) and treatment durations (2-12 weeks). The small number of paediatric trials and the absence of separate data from studies involving adolescents precluded the independent analysis of younger age groups.

DISCLOSURES:

This study was funded by the European Consortium for Eosinophilic Diseases of the Gastrointestinal Tract. The funder had no direct involvement in the study. One author reported receiving consulting fees, payment or honoraria for lectures, and payments for the conduct of clinical trials of products from various pharmaceutical companies.

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