Which agents improve histology in EoE?

Several medications such as orodispersible budesonide (ODB), oral viscous budesonide (OVB), and fluticasone, among others, demonstrate efficacy in the treatment of eosinophilic esophagitis (EoE) in adults and children, according to the results of a network meta-analysis.

A team of researchers conducted a comprehensive review of the databases of Embase, PubMed, Medline Ovid, Cochrane Central, and Web of Science through 10 May 2023. Using a random effects model, they performed a frequentist approach network meta-analysis.

Twenty-five randomized controlled trials, involving 25 distinct interventions and 2,067 patients, were included in the meta-analysis.

Ranked in decreasing order, the following interventions improved histology when compared with placebo: ODB low dose, ODB high dose, OVB high dose, fluticasone tablet 1.5 mg twice daily, fluticasone 3 mg twice daily, esomeprazole, dupilumab every 2 weeks, dupilumab weekly, OVB medium dose, fluticasone 3 mg daily, cendakimab 180 mg, prednisone, swallowed fluticasone, fluticasone tablet 1.5 mg daily, OVB low dose, reslizumab 3 mg/kg, reslizumab 1 mg/kg, and reslizumab 2 mg/kg.

“Because of the heterogeneity and large effect size, we recommend more trials comparing pharmacotherapeutic interventions with each other and placebo,” the researchers said.

This study was limited by the lack of clinical efficacy data, heterogeneity of operator, population, and outcome analysis.