A prospective open clinical trial of a proton pump inhibitor, elimination diet and/or budesonide for eosinophilic oesophagitis

Philpott, Hamish; Nandurkar, Sanjay; Royce, Simon G.; Thien, Francis; Gibson, Peter R.

doi:10.1111/apt.13576

Cited by 71 publications

(87 citation statements)

References 23 publications

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“…Nonetheless, four studies considered remission within the range of 0 to ≤5 eosinophils/hpf, 42, 43, 44, 45 and five studies considered remission as having ≤15 eosinophils/hpf 46, 47, 48, 49, 50…”

Section: Resultsmentioning

confidence: 99%

Systematic review of histological remission criteria in eosinophilic esophagitis

Eke

White

et al. 2018

JGH Open

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Elemental diets, dietary elimination, and steroid therapies are the most common therapies in the clinical trials for eosinophilic esophagitis (EoE). Histological findings (usually reported as eosinophils per microscopic high‐powered field [hpf]) remain the most common end‐point used to define response. Yet, the threshold for defining “response” and “remission” are ill‐defined among consensus guidelines and may vary from study to study. We conducted a systematic literature review of articles on eosinophilic esophagitis, published between January 2007 and November 2017, considering histological remission as the primary outcome. We abstracted treatment information and definitions of histological remission or response. A comparison of definitions of histological remission across and within institutions was performed. A total of 61 articles were included in this review, with approximately 60% of the studies published from centers in the United States. Histological definitions of remission of EoE ranged from 0 to ≤20 eosinophils/hpf. The most stringent criteria, ranging from 0 to ≤5 eosinophils/hpf, were commonly used in interventional trial studies that examined the effects of new treatments. We found remarkable variability in definitions between studies, treatment types, and regions. Age or epidemiological distribution of study subjects did not influence the criteria for histological remission. Clinical and histological improvements are important measures of the effects of treatment. Histological findings, the most objective measure of treatment, should provide an optimal method for comparing the effectiveness of various treatments. Yet, our findings suggest a lack of consistent remission criteria in published studies. Considering these inconsistencies, it is difficult to compare the effectiveness of various treatments.

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Section: Resultsmentioning

confidence: 99%

Systematic review of histological remission criteria in eosinophilic esophagitis

Eke

White

et al. 2018

JGH Open

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“…Systematic review yielded eight studies with data regarding the effectiveness of SFED 18, 23, 28–33 and twenty-five studies 3–27 regarding the effectiveness of tCS from which model parameters for symptom response and change in eosinophil count were derived by meta-regression. Seven studies described dilation in patients with EoE.…”

Section: Resultsmentioning

confidence: 99%

“…SFED has been studied only among patients who desire to pursue such therapy. 18, 23, 28–33 SFED can be expensive and difficult for some patients to undertake. 63 …”

Section: Discussionmentioning

confidence: 99%

“…2 However, the two medical therapies supported by a broad base of evidence are topical corticosteroids (tCS) 3–27 and six-food elimination diet (SFED). 18, 23, 28–33 Esophageal dilation is also used for treatment of strictures or narrowing, 34–40 but because it does not impact mucosal inflammation 39 it has not been recommended as monotherapy in societal guidelines. 1 …”

Section: Introductionmentioning

confidence: 99%

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Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis

Cotton

Erim

Eluri

et al. 2017

Clinical Gastroenterology and Hepatology

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Background & Aims Topical corticosteroids or dietary elimination are recommended as first-line therapies for eosinophilic esophagitis (EoE), but data to directly compare these therapies are scant. We performed a cost utility comparison of topical corticosteroids and the 6 food elimination diet (SFED) in treatment of EoE, from the payer perspective. Methods We used a modified Markov model based on current clinical guidelines, in which transition between states depended on histologic response simulated at the individual cohort-member level. Simulation parameters were defined by systematic review and meta-analysis to determine the base case estimates and bounds of uncertainty for sensitivity analysis. Meta-regression models included adjustment for differences in study and cohort characteristics. Results In the base case scenario, topical fluticasone was about as effective as SFED but more expensive at a 5-year time horizon ($9261.58 vs $5719.72 per person). SFED was more effective and less expensive than topical fluticasone and topical budesonide in the base case scenario. Probabilistic sensitivity analysis revealed little uncertainty in relative treatment effectiveness. There was somewhat greater uncertainty in the relative cost of treatments—most simulations found SFED to be less expensive. Conclusion In a cost utility analysis comparing topical corticosteroids and SFED for first-line treatment of EoE, the therapies were similar in effectiveness. SFED was on average less expensive, and more cost effective in most simulations, than topical budesonide and topical fluticasone, from a payer perspective and not accounting for patient-level costs or quality of life.

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“…Since this time, three additional comparison studies have demonstrated lower success rates with the SFED (52–56 %) in adults [61, 75, 66•,]. These studies, however, differed from the those previously mentioned in a number of ways.…”

Section: Dietary Therapy In Eosinophilic Esophagitismentioning

confidence: 95%

Eosinophilic Esophagitis From an Allergy Perspective: How to Optimally Pursue Allergy Testing & Dietary Modification in the Adult Population

McGowan

Platts-Mills

2016

Curr Gastroenterol Rep

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Eosinophilic esophagitis (EoE) is a clinicopathologic condition characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. In adults, the three most common treatment options are swallowed steroids, elimination diets, and periodic esophageal dilations. Many different elimination diets have been studied in adults, including elemental diets, allergy testing-directed diets, and empiric elimination diets. This article will review the existing data on these dietary therapies and will propose an approach to dietary management in adult EoE.

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A prospective open clinical trial of a proton pump inhibitor, elimination diet and/or budesonide for eosinophilic oesophagitis

Cited by 71 publications

References 23 publications

Systematic review of histological remission criteria in eosinophilic esophagitis

Systematic review of histological remission criteria in eosinophilic esophagitis

Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis

Eosinophilic Esophagitis From an Allergy Perspective: How to Optimally Pursue Allergy Testing & Dietary Modification in the Adult Population

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