Efficacy and Safety of Budesonide in the Treatment of Eosinophilic Esophagitis: Updated Systematic Review and Meta-Analysis of Randomized and Non-Randomized Studies

Abstract

Background and ObjectiveEosinophilic esophagitis (EE) is an immune/antigen-driven inflammation that causes esophageal dysfunction. Budesonide has shown promising effect in the management of EE in multiple studies, and we therefore conducted this systematic review/meta-analysis to assess budesonide efficacy and safety in order to provide more updated and robust evidence.MethodsIn April 2018, we conducted a systematic electronic search through four databases: PubMed, Scopus, Web of Science (ISI), and Cochrane Central. All original studies reporting the efficacy of budesonide in the treatment of EE were included in our meta-analysis. The Cochrane Collaboration tool was employed to assess the risk of bias among included randomized controlled trials, while the Newcastle–Ottawa Scale was used for non-randomized studies.ResultsA total of 12 studies including 555 participants were included in our review. Budesonide showed marked efficacy at the level of histological response compared to placebo [risk ratio (RR) (95% confidence interval (CI)) 11.93 (4.82–29.50); p > 0.001]. Analysis of randomized and non-randomized studies revealed considerable reduction in eosinophil count, with a mean difference (MD) (95% CI) of − 69.41 (− 105.31 to − 33.51; p < 0.001) and 46.85 (33.93–59.77; p < 0.001), respectively. Similarly, there was a marked improvement in the clinical symptoms via the analysis of randomized and non-randomized studies, with an RR (95% CI) of 1.72 (1.22–2.41; p = 0.002) and MD (95% CI) of 2.45 (0.76–4.15; p = 0.005), respectively.ConclusionBudesonide showed significant effect at all treatment endpoints. However, since budesonide carries a risk of candidiasis and our inferences are based only on a small number of included studies, more research is warranted to clarify these results.Electronic supplementary materialThe online version of this article (10.1007/s40268-018-0253-9) contains supplementary material, which is available to authorized users.

Diagnosis and treatment of eosinophilic esophagitis

“…74 A recent meta-analysis of budesonide showed overall efficacy for all clinical end points, with a histologic response of budesonide to placebo that demonstrated that efficacy of budesonide over placebo generated an overall relative risk of 11.93 (P < .001) in 245 pediatric and adult patients. 75 Long-term TCS therapy is indicated in patients with EoE because of frequent recurrence with TCS removal. However, spontaneous increases in esophageal eosinophil counts despite continued therapy is not uncommon.…”

Challenges and updates in the management of eosinophilic esophagitis

“…Budesonide has been evaluated in randomized trials in the treatment of EE. This was confirmed by the first systematic review and meta-analysis conducted by Rawla et al in 2018, comprising both randomized and non-randomized studies, which included 12 studies and a total of 555 participants [31]. This study showed that topical budesonide exerts substantial effects at all treatment endpoints [31].…”

An updated review of pancreatic cystic lesions

“…They occur more commonly in women and generally present during the third and fourth decades of life [86,87]. SPNs can occur throughout the pancreas but usually occur in the pancreatic body or tail [88,89]. Macroscopically, SPNs appear as large, well-demarcated, solitary, mixed solid, and cystic heterogeneous masses.…”