Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial.

Abstract

BACKGROUND & AIMS:

Swallowed topical-acting corticosteroids are recommended as first-line therapy for eosinophilic esophagitis (EoE). Asthma medications not optimized for esophageal delivery are sometimes effective, although given off-label. We performed a randomized, placebo-controlled trial to assess the effectiveness and tolerability of a budesonide orodispersible tablet (BOT), which allows the drug to be delivered to the esophagus in adults with active EoE.

METHODS:

We performed a double-blind, parallel study of 88 adults with active EoE in Europe. Patients were randomly assigned to groups that received BOT (1 mg twice daily; n = 59) or placebo (n = 29) for 6 weeks. The primary end point was complete remission, based on clinical and histologic factors, including dysphagia and odynophagia severity ≤2 on a scale of 0-10 on each of the 7 days before the end of the double-blind phase and a peak eosinophil count <5 eosinophils/high power field. Patients who did not achieve complete remission at the end of the 6-week double-blind phase were offered 6 weeks of open-label treatment with BOT (1 mg twice daily).

RESULTS:

At 6 weeks, 58% of patients given BOT were in complete remission compared with no patients given placebo (P < .0001). The secondary end point of histologic remission was achieved by 93% of patients given BOT vs no patients given placebo (P < .0001). After 12 weeks, 85% of patients had achieved remission. Six-week and 12-week BOT administration were safe and well tolerated; 5% of patients who received BOT developed symptomatic, mild candida, which was easily treated with an oral antifungal agent.

CONCLUSIONS:

In a randomized trial of adults with active EoE, we found that budesonide oral tablets were significantly more effective than placebo in inducing clinical and histologic remission. Eudra-CT number 2014-001485-99; ClinicalTrials.gov ID NCT02434029.

• Authors: Alfredo J Lucendo, Stephan Miehlke, Christoph Schlag, Michael Vieth, Ulrike von Arnim, Javier Molina-Infante, Dirk Hartmann, Albert Jan Bredenoord, Constanza Ciriza de Los Rios, Stefan Schubert, Stefan Brückner, Ahmed Madisch, Jamal Hayat, Jan Tack, Stephen Attwood, Ralph Mueller, Roland Greinwald, Alain Schoepfer, Alex Straumann, International EOS-1 Study Group
• Journal: Gastroenterology (Gastroenterology) Vol. 157 Issue 1 Pg. 74-86.e15 (07 2019) ISSN: 1528-0012 [Electronic] United States
• PMID: 30922997 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 AGA Institute. Published by Elsevier Inc. All rights reserved.

Chemical References

• Antifungal Agents
• Glucocorticoids
• Tablets
• Budesonide

Topics

• Administration, Oral
• Adult
• Antifungal Agents (therapeutic use)
• Budesonide (administration & dosage)
• Candidiasis, Oral (chemically induced, drug therapy)
• Double-Blind Method
• Eosinophilic Esophagitis (drug therapy, pathology)
• Esophagoscopy
• Female
• Glucocorticoids (administration & dosage)
• Humans
• Male
• Middle Aged
• Tablets
• Treatment Outcome