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.