EoE remission feasible with once-daily budesonide

Treatment with budesonide once daily effectively maintains endoscopic and histologic remission in most patients with eosinophilic esophagitis (EoE), which is similar to reported outcomes with twice daily dosing, according to a study.

“There is, however, a subgroup of patients that will have a resurgence of peak eosinophil count (PEC) after dose reduction, which emphasizes the need for clinical, endoscopic, and histologic follow-up,” the researchers said.

Twenty-nine patients with EoE were included in this retrospective analysis and were treated with swallowed topical corticosteroids (STC; 1 mg: n=28; 0.5 mg: n=1), either budesonide orodispersible tablet (BOT; n=12) or budesonide viscous solution (BVC; n=17). They were contacted to fill out online questionnaires regarding symptoms and health-related quality of life (HRQOL).

Histologic remission, the primary endpoint, was defined as PEC <15 eosinophils per high power field (HPF) after >12 weeks of budesonide once daily.

Of the patients, 86 percent achieved histologic remission after a median follow-up of 767 days on once-daily dosing. [J Clin Gastroenterol 2026;60:136-142]

Histologic disease activity persisted in four patients, of whom one received BOT. Two patients had a slight increase in PEC following dose reduction of BVS to once daily (to PEC of 25 and 35/HPF, respectively), but they achieved histologic remission after switching the formulation to BOT once daily.

“Although subgroups were small and not powered to demonstrate a difference between formulations, BOT was numerically more efficient in maintaining histologic remission with once-daily dosing than BVS (92 percent vs 82 percent),” the researchers said.

“Moreover, when switching two patients with active disease on BVS 1 mg once daily to BOT 1 mg once daily off-label, both achieved remission, suggesting a superior esophageal drug disposition with BOT vs BVS,” they added.

Twice daily dosing

Previous trials have reported high histologic remission rates (>90 percent) with twice daily dosing of budesonide in different formulations, such as viscous solutions, off-label swallowed nebulized solutions, and orodispersible tablets.

For instance, both 1 and 2 mg twice daily dosing effectively induced remission, and both 0.5 and 1 mg twice daily dosing sustained remission for up to 3 years. [Gut 2016;65:390-399; Gastroenterology 2019;157:74-86.e15; Clin Gastroenterol Hepatol 2019;17:666-673.e8; Gastroenterology 2020;159:1672-1685.e5; Clin Gastroenterol Hepatol 2011;9:400-409.e1]

However, previous studies have also reported that many patients were not able to maintain remission after receiving very low doses of STC (0.25 mg twice daily). [Clin Gastroenterol Hepatol 2011;9:400-409.e1; Am J Gastroenterol 2017;112:1527-1535]

Moreover, STC use may elicit mild side effects, such as oropharyngeal and esophageal candidiasis (10 to 30 percent), which can be easily treated with antifungal medication. [United European Gastroenterol J 2017;5:335-358; Gastroenterology 2020;159:1672-1685.e5]

“As expected, we did not observe major side effects on a low-dose STC, with esophageal candidiasis being suspected or histologically confirmed in 34 percent of patients (10/29), which is consistent with previous reports,” the researchers said.