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JOURNAL ARTICLE
Muhammad Aziz, Hossein Haghbin, Manesh K Gangwani, Rawish Fatima, Amir H Sohail, Hassam Ali, Zakaria A Alyousif, Dushyant S Dahiya, Wade Lee-Smith, Azizullah Beran, Faisal Kamal, Ali Nawras
INTRODUCTION: Multiple pharmacological interventions have been studied for managing eosinophilic esophagitis (EoE). We performed a comprehensive systematic review and network meta-analysis of all available randomized controlled trials (RCT) to assess the efficacy and safety of these interventions in EoE in adults and children. METHODS: We performed a comprehensive review of Embase, PubMed, MEDLINE OVID, Cochrane CENTRAL, and Web of Science through May 10, 2023. We performed frequentist approach network meta-analysis using random effects model...
May 6, 2024: Journal of Clinical Gastroenterology
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JOURNAL ARTICLE
Emilio J Laserna-Mendieta, Pilar Navarro, Sergio Casabona-Francés, Edoardo V Savarino, Edurne Amorena, Isabel Pérez-Martínez, Danila Guagnozzi, Leonardo Blas-Jhon, Elena Betoré, Antonio Guardiola-Arévalo, Gaia Pellegatta, Anne Lund Krarup, Antonia Perello, Jesús Barrio, Carolina Gutiérrez-Junquera, Carlos Teruel Sánchez-Vegazo, Sonia Fernández-Fernández, Juan Enrique Naves, Salvatore Oliva, Juan Armando Rodríguez-Oballe, Silvia Carrión, Silvia Espina, Mónica Llorente Barrio, Maria Lluisa Masiques-Mas, Raffaella Dainese, Sara Feo-Ortega, Verónica Martín-Dominguez, Jennifer Fernández-Pacheco, Maria Teresa Pérez-Fernández, Matteo Ghisa, Daria Maniero, Óscar Nantes-Castillejo, Julia Nicolay-Maneru, Adolfo Suárez, Iván Maray, Ronald Llerena-Castro, Adriana Ortega-Larrodé, Javier Alcedo, Alicia Granja Navacerrada, Francesca Racca, Cecilio Santander, Ángel Arias, Alfredo J Lucendo
BACKGROUND: Swallowed 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. OBJECTIVE: To assess the effectiveness of topical corticosteroid therapy for EoE in real-world practice. METHODS: Cross-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...
January 29, 2024: United European Gastroenterology Journal
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JOURNAL ARTICLE
Erin Phillips Syverson, Michelle Tobin, Tiffany Patton, James P Franciosi, Sandeep K Gupta, Rajitha D Venkatesh
Given the variety of preparations and lack of standardization of swallowed topical corticosteroids (STC) for treatment of eosinophilic esophagitis (EoE), we sought to better understand STC prescribing practices of pediatric gastroenterologists. A 12-question survey was distributed to members of North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Eosinophilic Gastrointestinal Disease Special Interest Group and responses were analyzed. Forty-two of 68 physicians responded. Oral viscous budesonide (OVB) was overall first choice STC in 31 (74%) survey respondents, with OVB most frequently utilized in patients under 5 years old and fluticasone propionate in patients 13-18 years old...
August 1, 2023: Journal of Pediatric Gastroenterology and Nutrition
#4
JOURNAL ARTICLE
Renato Tambucci, Marco Roversi, Francesca Rea, Monica Malamisura, Giulia Angelino, Isabella Biondi, Raffaele Simeoli, Bianca Maria Goffredo, Paola Francalanci, Alessandra Simonetti, Susanna Livadiotti, Tiziana Corsetti, Luigi Dall'Oglio, Paolo Rossi, Giuseppe Pontrelli, Paola De Angelis
OBJECTIVES: A high prevalence of eosinophilic esophagitis (EoE) has been reported in children with repaired esophageal atresia (EA). Topical steroids proved to be an effective and safe therapy in EoE, although not approved in pediatrics. We report the results of the first clinical trial of oral viscous budesonide (OVB) performed in children with EoE after repaired esophageal atresia (EoE-EA). METHODS: This open-label, single-arm, phase 2 clinical trial with randomized pharmacokinetic sampling, was conducted at the Bambino Gesù Children's Hospital between September 2019 and June 2021...
August 1, 2023: Journal of Pediatric Gastroenterology and Nutrition
#5
JOURNAL ARTICLE
Joanna Warzecha, Marcin Dziekiewicz, Alicja Bieńkowska-Tokarczyk, Maciej Małecki, Aleksandra Banaszkiewicz
Eosinophilic esophagitis (EoE) is a chronic disease, characterized clinically by esophageal disfunction. Topical corticosteroids (tCS), predominantly fluticasone and budesonide, are considered the effective first line treatment, as well as an option of maintenance therapy in EoE. The way that tCS are administered significantly affects their effectiveness. There is still no ready-to-use steroid drug to be applied topically to the esophagus in children-a few experimental viscous slurries (mainly of budesonide) have been shown in trials to be more effective than steroids administered via metered dose inhalers (MDIs) and swallowed...
November 14, 2022: Journal of Clinical Medicine
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JOURNAL ARTICLE
Lay Q Ng, Wenyin Loh, Jia X Ong, Khurshid Merchant, Fang K Chiou
AIM: Paediatric eosinophilic gastritis (EG) is a rare disorder and existing literature on diagnostic criteria and management remains lacking. We aim to describe the clinical spectrum and assess the efficacy of dietary elimination and proton-pump inhibitor (PPI) therapy, with particular emphasis on histologic remission in children with primary EG. METHODS: We performed a retrospective study of patients aged 0-18 years diagnosed with EG at a single centre in Singapore from 2013 to 2021...
April 7, 2022: Journal of Paediatrics and Child Health
#7
JOURNAL ARTICLE
Salvatore Oliva, Danila Volpe, Giusy Russo, Silvio Veraldi, Paola Papoff, Carla Giordano, Cosimo Ruggiero, Chiara Maria Trovato, Gianluca Terrin, Danilo Rossetti
Eosinophilic esophagitis (EoE) is an immune-mediated condition characterized by symptoms of esophageal dysfunction and an eosinophilic inflammation of the esophagus.1 Swallowed topical steroids represent one of the possible strategies for inducing and maintaining remission in EoE.2 To date, a validated maintenance strategy has yet to be defined, especially in children. The available evidence suggests decreasing the dose after a successful induction therapy.3 No study has reported the efficacy of a continuous progressive dose reduction; thus, it is unknown if all patients need to use the same dosages and for how long...
December 2022: Clinical Gastroenterology and Hepatology
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RANDOMIZED CONTROLLED TRIAL
Ivy H Song, Richard D Finkelman, Lan Lan
BACKGROUND AND OBJECTIVES: Currently, there are no US FDA-approved therapies for eosinophilic esophagitis (EoE). Budesonide oral suspension (BOS; SHP621, TAK-721) is a viscous, muco-adherent, oral formulation of budesonide that is in phase III development for the treatment of EoE. BOS 2 mg twice daily was studied in 12- and 36-week phase III studies for the induction and maintenance of clinical remission in adults and adolescents with EoE (NCT02605837 and NCT02736409). ENTOCORT EC is a gelatin capsule formulation of budesonide that is FDA-approved for the treatment of mild-to-moderate active Crohn's disease (CD) in adults and children...
December 2020: Drugs in R&D
#9
JOURNAL ARTICLE
Elizabeth T Jensen, Carl D Langefeld, Kip D Zimmerman, Timothy D Howard, Evan S Dellon
BACKGROUND: Treatment failure in eosinophilic esophagitis (EoE) is common. We hypothesize that DNA methylation differs between patients by treatment response to topical steroids (oral viscous budesonide), thus offering the potential to inform targeting therapies. OBJECTIVE: We sought to identify differentially methylated sites and affiliated genes in pre-treatment oesophageal cells between responders and non-responders and test for accelerated epigenetic ageing in oesophageal cells of EoE patients...
December 2020: Clinical and Experimental Allergy
#10
JOURNAL ARTICLE
Eyal Zur
In their article, Casiraghi, A. et al. describe a few relevant methods to assess the quality of a pharmaceutical preparation of oral viscous budesonide, intended to be swallowed, and treat the esophagus in eosinophilic esophagitis patients. They choose the following methods for this purpose: rheological properties, syringeability, mucoadhesiveness, and in vitro penetration of budesonide in porcine esophageal tissue. At the end of the article, they concluded that the best formulation of oral viscous budesonide was the one already being used in hospitals, based on xanthan gum...
August 31, 2020: Pharmaceutics
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JOURNAL ARTICLE
Valentino Laquintana, Mulazim Hussain Asim, Angela Lopedota, Annalisa Cutrignelli, Antonio Lopalco, Massimo Franco, Andreas Bernkop-Schnürch, Nunzio Denora
Budesonide (BUD) is a low water soluble (S0 = 5.028·10-5 M) corticosteroid used as preferred therapy for the treatment of Eosinophilic Esophagitis (EoE), a chronic allergic-immune condition with an increased incidence in the paediatric population. Currently there are no commercial medicines indicated for EoE, and, therefore, in the hospital pharmacy the BUD is extemporaneously formulated as viscous oral suspension at the initial dose of 1-2 mg per day for children, highlighting the need of a mucoadhesive drug delivery system (MDDS) that adheres to the site of action and prolongs the therapeutic activity of the administered drug...
December 15, 2019: International Journal of Pharmaceutics
#12
JOURNAL ARTICLE
Evan S Dellon, John T Woosley, Ashley Arrington, Sarah J McGee, Jacquelyn Covington, Susan E Moist, Jessica H Gebhart, Joseph A Galanko, John A Baron, Nicholas J Shaheen
BACKGROUND & AIMS: Eosinophilic esophagitis (EoE) is chronic and recurs if treatment is discontinued. We aimed to determine rates of recurrence, and whether initial treatment with oral viscous budesonide (OVB) resulted in less recurrence than fluticasone from a multidose inhaler (MDI). METHODS: This was the observation phase of a randomized, double-blind, double-dummy trial comparing OVB with MDI for initial EoE treatment. Subjects with a histologic response (<15 eosinophils/high-power field) in the trial entered an observation phase in which treatment was discontinued and symptoms were monitored...
September 6, 2019: Clinical Gastroenterology and Hepatology
#13
RANDOMIZED CONTROLLED TRIAL
Evan S Dellon, John T Woosley, Ashley Arrington, Sarah J McGee, Jacquelyn Covington, Susan E Moist, Jessica H Gebhart, Alexandra E Tylicki, Shiyan O Shoyoye, Christopher F Martin, Joseph A Galanko, John A Baron, Nicholas J Shaheen
BACKGROUND AND AIMS: Topical steroid treatments for eosinophilic esophagitis (EoE) include swallowed fluticasone from a multi-dose inhaler (MDI) or oral viscous budesonide (OVB) slurry, but the 2 have never been compared. We assessed whether OVB was more effective than MDI for initial treatment of patients with EoE. METHODS: In a double-blind, double-dummy trial, patients with a new diagnosis of EoE were randomly assigned to groups given 8 weeks of either OVB (1 mg/4 mL) twice daily plus a placebo inhaler (n = 56) or fluticasone MDI (880 μg) twice daily plus a placebo slurry (n = 55)...
July 2019: Gastroenterology
#14
JOURNAL ARTICLE
Salvatore Oliva, Danilo Rossetti, Paola Papoff, Antonio Tiberti, Saverio Mallardo, Danila Volpe, Cosimo Ruggiero, Giusy Russo, Debora Vezzoli, Sara Isoldi, Salvatore Cucchiara
BACKGROUND: A new prepared oral viscous budesonide (PVB) has been effective in inducing clinical and histological remission in pediatric eosinophilic esophagitis (EoE). AIMS: To evaluate the efficacy of a 12-week maintenance therapy on clinical, endoscopic, and histological remission using half of the dose used in the induction therapy. METHODS: We prospectively enrolled pediatric patients with active EoE. After 12 weeks of induction therapy with PVB (< 150 cm: 2 mg/day; ≥ 150 cm: 4 mg/day) patients received a maintenance dose of half of the dose used in the induction therapy (1 mg or 2 mg) for another 12 weeks...
June 2019: Digestive Diseases and Sciences
#15
JOURNAL ARTICLE
Aakash Goyal
PURPOSE OF REVIEW: Eosinophilic esophagitis (EoE) is a relatively new disease but its understanding is evolving over a period of time. This review highlights recent advances in the understanding of pathophysiology, diagnostic modalities, short and long-term goals of therapy and novel therapeutic agents. RECENT FINDINGS: The prevalence of EoE is increasing. Upper endoscopy and biopsy remains the gold standard for diagnosing EoE but less invasive and more cost-effective testing has been under investigation...
October 2018: Current Opinion in Pediatrics
#16
JOURNAL ARTICLE
Craig C Reed, Claire Fan, Nathaniel Koutlas, Zoe Stefanadis, Swathi Eluri, Nicholas J Shaheen, Evan S Dellon
Aim: Because no approved medications exist for eosinophilic esophagitis (EoE), patients must use off-label drugs or create their own formulations. We assessed the efficacy of a standardized compounded budesonide suspension for treatment of EoE. Materials and methods: We conducted a retrospective cohort study of EoE patients at the University of North Carolina treated with compounded budesonide dispensed by a specialty compounding pharmacy. Outcomes (symptomatic global response [yes/no], endoscopic response [% with individual findings], and histologic response [absolute eosinophil count; % with <15 eos/hpf])were assessed after the initial and last treatment in our system...
2018: HSOA Journal of Gastroenterology & Hepatology Research
#17
COMPARATIVE STUDY
Craig C Reed, Anca M Safta, Shadi Qasem, M Angie Almond, Evan S Dellon, Elizabeth T Jensen
BACKGROUND: Few studies have examined combined or alternating treatment algorithms in eosinophilic esophagitis. AIMS: We conducted a retrospective cohort study to ascertain the efficacy and adherence to a combined and alternating treatment approach with topical corticosteroids and 2-food elimination diet for pediatric EoE. METHODS: Patients were prescribed a 2-food elimination diet (milk and soy) and topical corticosteroid (fluticasone or oral viscous budesonide) for 3 months, after which the steroid was discontinued and 2-food elimination diet continued for 3 months...
September 2018: Digestive Diseases and Sciences
#18
JOURNAL ARTICLE
Eitan Rubinstein, Elizabeth E Hait, Paul D Mitchell, John J Lee
BACKGROUND: Eosinophilic esophagitis (EoE) is a clinicopathologic disorder characterized histologically by esophageal eosinophilia. Oral viscous budesonide (OVB) is an effective treatment with remission rates reported between 55% and 87%; however, topical corticosteroids are associated with increased risk of candidal esophagitis and adrenal suppression. Attempts to decrease the daily dose of topical steroids have resulted in disease relapse. The objective of this study was to determine whether or not reducing the frequency of OVB administration would be effective in controlling esophageal eosinophilia in children and adolescents...
March 2018: Journal of Pediatric Gastroenterology and Nutrition
#19
JOURNAL ARTICLE
Jacqueline M Fable, Marina Fernandez, Susan Goodine, Trudy Lerer, Wael N Sayej
BACKGROUND: Eosinophilic esophagitis (EoE) is treated with dietary modification and/or pharmacologic management with swallowed topical steroids. Swallowed fluticasone propionate (FP) and oral viscous budesonide (OVB) have proven to be effective in resolving symptoms and reversing histologic changes in children and adults with EoE. There are minimal comparative studies between the 2 agents. OBJECTIVE: The aim of the study was to retrospectively compare endoscopic and histologic outcomes after FP versus OVB therapy in children with EoE in our center...
January 2018: Journal of Pediatric Gastroenterology and Nutrition
#20
JOURNAL ARTICLE
Alexandra Ahmet, Eric I Benchimol, Ellen B Goldbloom, Janice L Barkey
BACKGROUND: Adrenal suppression (AS), a glucocorticoid (GC) side effect associated with significant morbidity, is well described related to inhaled corticosteroid therapy for asthma. Swallowed topical glucocorticoid therapy is the main pharmacotherapy treatment for eosinophilic esophagitis (EoE) and therefore children with EoE are potentially at increased risk of AS. METHODS: In this prospective cohort study, we included children and youth <18 years diagnosed with EoE and treated with swallowed fluticasone or oral viscous budesonide for more than 1 month...
2016: Allergy, Asthma, and Clinical Immunology
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