Swallowed topical corticosteroids (STCs) are efficacious in
inducing clinical, endoscopic, and histological remission in
patients with active eosinophilic esophagitis (EoE) and represents a first line therapy for the disease. Its use in the long term has demonstrated they are also able to maintain remission. However, whether maintenance treatment can be stopped one patients have achieve a long-lasting remission of EoE remained unkown.
The relative paucity of data on long-term management of EoE with topical corticosteroids is such that even simple questions, including “How long should patients be treated with this therapy?”, “Does long-term administration of topical corticosteroids in the esophagus harbor a risk for mucosal atrophy?”, and “Can EoE be cured following long-term administration of these drugs?” remained unanswered.
A recent research developed by the Swiss EoE study group with Dr. Thomas Greuter as first author and published in The American Jorunal of Gastroenterology has tried to answer these questions by bringing patients into clinical, endoscopic, and histological remission, and assessing whether patients achieving such a remission for at least 6 months could or not discontinue the therapy.
The authors restrospectively evaluated patients included in a large database who were treated for EoE using swallowed topical corticosteroids at the Swiss EoE Clinics in Olten, Switzerland. The patients with a baseline visit and at least one follow-up visit (follow-up time ≥1 year) were standardizedly assessed for symptoms as well as endoscopic and histologic findings (from the proximal and from the distal esophagus) at least once anualy, while maintained treatment with swallowed topical corticosteroids. After achieving long-lasting (≥6 months) “deep remission” (as defined on the above), treatment with steroids was discontinued. Patients then attended follow-up visits every 3 months (or more frequently in case of reappearance of EoE-related symptoms).
Of the 351patients analyzed in this research, 33 (9.4%) achieved deep remission and stoped their treatment. A clinical relapse occurred in 26 patients (78.8%) after the cessation of treatment, whereas 1 patient (3.0%) experienced a histological relapse without any clinical symptoms. Overall, the majority of patients (81.8%) experienced a clinical relapse after cessation of the STC that occurred after a median time of 22.4 weeks.
In only 1.7% of EoE patients, swallowed topic steroids were discontinued in the long term.
Based on our data, the current understanding of EoE, and the
currently available medical treatment modalities, we can neither
counsel our patients that EoE is curable nor that a lifetime treatment will be necessary. Th erefore, a long-term monitoring of EoE patients treated with swallowed topic steroids is advisable.