Formulations of Topical Steroids in Eosinophilic Esophagitis—Current Treatment and Emerging Possibilities

Główczewski, Adam; Krogulska, Aneta

doi:10.3390/jcm11051454

Cited by 11 publications

(11 citation statements)

References 86 publications

(130 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Vonoprazan, a potassium-competitive acid blocker (P-CAB) with a different molecular structure from PPIs, is proposed as an alternative treatment not only for naive EoE but also for PPI-resistant EoE patients. More studies need to be conducted regarding this treatment for severe cases of EoE [50].…”

Section: Potassium-competitive Acid Blockermentioning

confidence: 99%

Eosinophilic gastrointestinal diseases: current perspectives on pathogenesis and management

Papaiakovou,

Papageorgiou,

Bakakos

et al. 2024

Explor Asthma Allergy

View full text Add to dashboard Cite

Eosinophilic gastrointestinal diseases (EGIDs) are a group of chronic conditions, characterized by an excessive accumulation of eosinophils in various areas of the mucosal of the gastrointestinal (GI) tract. EGIDs encompass a spectrum of diseases, including eosinophilic esophagitis (EoE), eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC), each affecting different segments of the GI tract. The pathogenesis of EGIDs is multifaceted and involves an intricate interplay between genetic predisposition, environmental triggers, and dysregulated immune responses. Although the exact etiology behind EGIDs is not fully understood, it is clear that they are immune-mediated, with eosinophils having a central role in inflammation and tissue damage of GI mucosal. Clinical manifestations depend on the organ that is affected by the disease and on the depth of the eosinophil infiltration of the bowel wall. They range from mild discomfort to severe dysphagia, abdominal pain, malnutrition, and growth failure, particularly in pediatric cases. Regarding EGID management, it is a challenging issue to achieve clinical and histologic remission using pharmacotherapy and dietary elimination. Corticosteroids and proton pump inhibitors can be selected as an effective first-line treatment for certain patients and six-food elimination diet (6-FED) has been proven effective in inducing remission. Furthermore, biologic therapies have emerged as essential tools in controlling eosinophilic-driven inflammation. This review focuses on the complex pathogenesis and treatment of these inflammatory diseases, especially EoE.

show abstract

Section: Potassium-competitive Acid Blockermentioning

confidence: 99%

Eosinophilic gastrointestinal diseases: current perspectives on pathogenesis and management

Papaiakovou,

Papageorgiou,

Bakakos

et al. 2024

Explor Asthma Allergy

View full text Add to dashboard Cite

show abstract

“…tC mostly based on flutiasone propionate (FP) and budesonide (BUD) formulations are extensively used to induce and maintain remission in real-world practice. 13 However, the use of different active ingredients and doses, administration methods, 11,[14][15][16] formula composition, 17 and changing volumes 18 have provided widely heterogeneous results. 19 Recently, a standardized formulation of tC based on BUD has become available on the market, providing predictable results in the majority of EoE patients.…”

Section: Introductionmentioning

confidence: 99%

“…tC mostly based on flutiasone propionate (FP) and budesonide (BUD) formulations are extensively used to induce and maintain remission in real‐world practice. 13 However, the use of different active ingredients and doses, administration methods, 11 , 14 , 15 , 16 formula composition, 17 and changing volumes 18 have provided widely heterogeneous results. 19 …”

Section: Introductionmentioning

confidence: 99%

Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real‐world efficacy from the EoE CONNECT registry

Laserna‐Mendieta,

Navarro,

Casabona‐Francés

et al. 2024

UEG Journal

View full text Add to dashboard Cite

BackgroundSwallowed topical corticosteroids (tC) are common therapy for patients with eosinophilic esophagitis (EoE). Widely heterogeneous results have occurred due to their active ingredients, formulations and doses.ObjectiveTo assess the effectiveness of topical corticosteroid therapy for EoE in real‐world practice.MethodsCross‐sectional study analysis of the multicentre EoE CONNECT registry. Clinical remission was defined as a decrease of ≥50% in dysphagia symptom scores; histological remission was defined as a peak eosinophil count below 15 per high‐power field. The effectiveness in achieving clinico‐histological remission (CHR) was compared for the main tC formulations.ResultsOverall, data on 1456 prescriptions of tC in monotherapy used in 866 individual patients were assessed. Of those, 904 prescriptions with data on formulation were employed for the induction of remission; 234 reduced a previously effective dose for maintenance. Fluticasone propionate formulations dominated the first‐line treatment, while budesonide was more common in later therapies. A swallowed nasal drop suspension was the most common formulation of fluticasone propionate. Doses ≥0.8 mg/day provided a 65% CHR rate and were superior to lower doses. Oral viscous solution prepared by a pharmacist was the most common prescription of budesonide; 4 mg/day provided no benefit over 2 mg/day (CHR rated being 72% and 80%, respectively). A multivariate analysis revealed budesonide orodispersible tablets as the most effective therapy (OR 18.9, p < 0.001); use of higher doses (OR 4.3, p = 0.03) and lower symptom scores (OR 0.9, p = 0.01) were also determinants of effectiveness.ConclusionReduced symptom severity, use of high doses, and use of budesonide orodispersible tablets particularly were all independent predictors of tC effectiveness.

show abstract

“…Some patients require a liquid formula diet provided via a feeding tube. Steroid medications can be used to control inflammation [ 39 , 40 ]. Esophageal dilation to relieve esophageal narrowing is also an established strategy for EE, especially in older adults and teenagers [ 41 ].…”

Section: Introductionmentioning

confidence: 99%

First Therapeutic Approval for Eosinophilic Esophagitis

Al‐Horani

Chiles

2022

Gastroenterology Insights

View full text Add to dashboard Cite

Eosinophilic esophagitis (EE) is a chronic, immune-mediated or antigen-mediated esophageal disease. Treatment for patients with EE can be challenging with no previously approved medications. Current management strategies follow the four D’s paradigm of drugs, dietary elimination, dilation, and disease anxiety and hypervigilance therapy. On 20 May 2022, dupilumab was approved by FDA for EE. A dose of 300 mg dupilumab weekly significantly improved signs and symptoms of EE compared to placebo in a phase 3 trial. The approval of dupilumab will fulfill an unmet need for the increasing number of patients with EE.

show abstract

Formulations of Topical Steroids in Eosinophilic Esophagitis—Current Treatment and Emerging Possibilities

Cited by 11 publications

References 86 publications

Eosinophilic gastrointestinal diseases: current perspectives on pathogenesis and management

Eosinophilic gastrointestinal diseases: current perspectives on pathogenesis and management

Swallowed topical corticosteroids for eosinophilic esophagitis: Utilization and real‐world efficacy from the EoE CONNECT registry

First Therapeutic Approval for Eosinophilic Esophagitis

Contact Info

Product

Resources

About