Histologic response to steroids in eosinophilic esophagitis is dependent on delivery compound

Abstract

Summary Topical steroids are commonly used in treatment of eosinophilic esophagitis (EoE), but currently there is lack of data to clarify most effective regimen. We aimed to study the achievement of histologic remission using the same dose of budesonide in two different delivery formulations. Patients with established EoE treated with pharmacy compounded budesonide capsule or budesonide Rincinol gel (both 3 mg twice daily) were studied retrospectively. Those with pre-treatment and post-treatment histologic assessment were included with main endpoint being histologic remission. 103 patients (62 gel, 41 capsule) were included, with higher rate of histologic remission with gel (84 vs. 59%, P=0.004). A subset of patients in both groups had lack of steroid response (<50% drop in eosinophils) (15% for gel, 32% for capsule). Formulation/delivery vehicle of steroid treatments to esophageal mucosa in EoE appears important for treatment efficacy, with budesonide gel having higher likelihood of histologic remission compared to budesonide capsules in our population. A truly steroid refractory group appears likely in our population. Larger, prospective studies may help clarify best regimen of topical steroids in EoE and may work to identify patients likely to benefit from alternative therapies.

Comparison of budesonide vehicles in inducing histologic remission in pediatric eosinophilic esophagitis

“…Despite the overall lower remission rates, our data suggests there is no difference in efficacy among the different delivery vehicles. An adult study demonstrated higher rates of remission using budesonide gel mixed with Rincinol gel as compared to budesonide capsules crushed into various vehicles such as Splenda, syrup, or honey 15 . This study, however, did not compare rates of remission between different vehicles used with budesonide capsules.…”

“…An adult study demonstrated higher rates of remission using budesonide gel mixed with Rincinol gel as compared to budesonide capsules crushed into various vehicles such as Splenda, syrup, or honey. 15 This study, however, did not compare rates of remission between different vehicles used with budesonide capsules. Our results are similar to other small prospective or retrospective cohort studies that showed favorable alternatives to standard OVB formulation with Splenda 8,10,11 and thus may address concerns regarding taste, cost, and possible adverse effects of consuming large amounts of sucralose.…”