Long-term topical corticosteroid use safe, effective in patients with EoE

Long-term treatment with topical corticosteroids in patients with eosinophilic esophagitis (EoE) is generally effective and safe, with only rare serious complications, reports a study.

A total of 431 patients with EoE treated with topical corticosteroids were screened in this retrospective cohort study. The investigators obtained histologic symptomatic and endoscopic responses from medical records. They compared patients who did and did not have long-term treatment at baseline and assessed outcomes at the last endoscopy.

Of the 431 patients, 104 met the eligibility criteria for long-term use. The median time on topical corticosteroids for eligible patients was 6.5 years. More than half (54 percent) of the participants had histologic response (<15 eos/hpf) at the last endoscopy, but those with excellent adherence had a histologic response of 64 percent.

Better adherence to treatment reduced endoscopic severity and strongly correlated with EoE Endoscopic Reference Score (1.7 vs 2.8 vs 4.0 for excellent, good, and poor adherence, respectively; p<0.001). Overall symptomatic response was 68 percent, but in those with poor adherence it was only 40 percent (p=0.07).

Notably, the use of topical corticosteroids led to rare complications (adrenal insufficiency, 1 percent; osteopenia, 1 percent; esophageal candidiasis, 4 percent at final endoscopy).

“These data can be used to help patients make clinical decisions about chronic topical corticosteroid use in EoE,” the investigators said.