Systematic review: adrenal insufficiency secondary to swallowed topical corticosteroids in eosinophilic oesophagitis

Abstract

Topical corticosteroids were associated with adrenal insufficiency in a minority of patients. Most cases came from uncontrolled observational studies, with widely varying definitions of adrenal insufficiency. Longer follow-up and larger controlled studies are needed to quantify the risk of adrenal insufficiency with maintenance topical corticosteroid therapy in EoE.

Letter: screening for adrenal suppression in paediatric inflammatory bowel disease

“…We agree with their observations related to the current heterogenous approach to testing for adrenal insufficiency in children with inflammatory bowel (IBD) disease receiving systemic corticosteroids. This mirrors our findings in patients receiving topical corticosteroids for eosinophilic oesophagitis 1,2.…”

Effect of Food Intake and Body Position on the Pharmacokinetics of Swallowed APT‐1011, a Fluticasone Orally Disintegrating Tablet, in Healthy Adult Volunteers

“…20,21 However, prolonged treatment with corticosteroids raises the risk of certain safety concerns including adrenal insufficiency, cardiovascular disease, impaired glucose homeostasis, infectious adverse events, osteoporosis, and neuropsychiatric adverse events. 22,23 Therefore, it is necessary to ensure that the exploration of an orally administered topical corticosteroid treatment, as proposed with APT-1011, will only have minimal systemic exposure to ensure safety with long-term use. As such, the observation that APT-1011 resulted in low bioavailability of fluticasone propionate is clinically important to the continued development of this product.…”

Letter: screening for adrenal suppression in paediatric inflammatory bowel disease – authors’ reply

“…We then performed a sensitivity analysis after excluding two studies that included patients with chronic hepatitis B or C infection. 2,3 The pooled OR was 1.70 (95% CI 0.78-3.68; P = 0.182; I 2 = 98.5%; P herterogeneity < 0.001) ( Figure 1B).…”

“…We read with great interest the recent observational study by Shao-met all inclusion criteria. [1][2][3][4][5] The pooled OR from these five studies was 1.58 (95% CI 0.91-2.76; P = 0.105; I 2 = 97.7%; P herterogeneity < 0.001) ( Figure 1A). We then performed a sensitivity analysis after excluding two studies that included patients with chronic hepatitis B or C infection.…”