PMID- 28719593
OWN - NLM
STAT- MEDLINE
DCOM- 20171019
LR  - 20181113
IS  - 1572-0241 (Electronic)
IS  - 0002-9270 (Linking)
VI  - 112
IP  - 10
DP  - 2017 Oct
TI  - Long-Term Treatment of Eosinophilic Esophagitis With Swallowed Topical 
      Corticosteroids: Development and Evaluation of a Therapeutic Concept.
PG  - 1527-1535
LID - 10.1038/ajg.2017.202 [doi]
AB  - OBJECTIVES: Swallowed topical corticosteroids (STCs) are efficacious in inducing 
      and presumably maintaining remission in patients with active eosinophilic 
      esophagitis (EoE). Hitherto, it has not been evaluated whether long-lasting 
      remission can be achieved, and whether treatment can be stopped once patients 
      have achieved this remission. METHODS: Since 2007, EoE patients included into a 
      large database at the Swiss EoE Clinics were put on STCs as induction/maintenance 
      therapy. Disease activity was assessed on an annual basis. In patients who 
      achieved long-lasting (>/=6 months) clinical, endoscopic, and histological (=deep) 
      remission, treatment was stopped. Data on all patients treated using this 
      therapeutic strategy were analyzed retrospectively. RESULTS: Of the 351 patients, 
      33 (9.4%) who were treated with STCs achieved deep remission. Median age of 
      remitters at disease onset was 32.6 years (interquartile range (IQR) 19.1-49.3), 
      and diagnostic delay was 5.4 years (IQR 1.2-11.4). Deep remission was achieved 
      after 89.0 weeks (IQR 64.6-173.8). Female gender was the only independent 
      prognostic factor for achieving deep remission (odds ratio (OR) 2.518, 95% 
      confidence interval (CI) 1.203-5.269). Overall, STCs were stopped after 104.7 
      weeks (IQR 65.5-176.6). No mucosal damage was observed upon histological 
      examination. In 27 of the 33 remitters (81.8%), a clinical relapse occurred after 
      a median of 22.4 weeks (95% CI 5.1-39.7). Six remitters (18.2%) did not 
      experience a clinical relapse during a follow-up of 35.1 weeks (IQR 18.3-44.9). 
      Hence, a total of 1.7% (6/351) patients were able to discontinue STCs in the long 
      term. CONCLUSIONS: Long-term EoE treatment with STCs was well tolerated, but only 
      a minority achieved deep remission. Female gender is the only prognostic factor 
      for attainment of such remission. After treatment cessation, the majority 
      experienced a clinical relapse.
FAU - Greuter, Thomas
AU  - Greuter T
AD  - Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, 
      Switzerland.
FAU - Bussmann, Christian
AU  - Bussmann C
AD  - Pathology Viollier AG, Basel, Switzerland.
FAU - Safroneeva, Ekaterina
AU  - Safroneeva E
AD  - Institute of Social and Preventive Medicine, University of Bern, Bern, 
      Switzerland.
FAU - Schoepfer, Alain M
AU  - Schoepfer AM
AD  - Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire 
      Vaudois (CHUV), Lausanne, Switzerland.
FAU - Biedermann, Luc
AU  - Biedermann L
AD  - Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, 
      Switzerland.
FAU - Vavricka, Stephan R
AU  - Vavricka SR
AD  - Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, 
      Switzerland.
AD  - Division of Gastroenterology and Hepatology, Triemli Hospital Zurich, Zurich, 
      Switzerland.
FAU - Straumann, Alex
AU  - Straumann A
AD  - Swiss EoE Clinics, Praxis Romerhof, Olten, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20170718
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Glucocorticoids)
SB  - IM
MH  - Administration, Oral
MH  - Adult
MH  - Databases, Factual
MH  - Drug Monitoring/methods
MH  - *Eosinophilic Esophagitis/diagnosis/drug therapy/epidemiology
MH  - Esophagoscopy/methods
MH  - Female
MH  - Follow-Up Studies
MH  - *Glucocorticoids/administration & dosage/adverse effects
MH  - Humans
MH  - *Long Term Adverse Effects/diagnosis/epidemiology/etiology
MH  - *Long-Term Care/methods/statistics & numerical data
MH  - Maintenance Chemotherapy/methods
MH  - Male
MH  - Middle Aged
MH  - Patient Acuity
MH  - Prognosis
MH  - Recurrence
MH  - Remission Induction/methods
MH  - Sex Factors
MH  - Switzerland/epidemiology
EDAT- 2017/07/19 06:00
MHDA- 2017/10/20 06:00
CRDT- 2017/07/19 06:00
PHST- 2017/02/22 00:00 [received]
PHST- 2017/05/23 00:00 [accepted]
PHST- 2017/07/19 06:00 [pubmed]
PHST- 2017/10/20 06:00 [medline]
PHST- 2017/07/19 06:00 [entrez]
AID - ajg2017202 [pii]
AID - 10.1038/ajg.2017.202 [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2017 Oct;112(10):1527-1535. doi: 10.1038/ajg.2017.202. Epub 
      2017 Jul 18.