Currently Available Drugs Work for Patients With Eosinophilic Esophagitis

Presently, there is no specific drug recommendation as the preferred treatment for active eosinophilic esophagitis (EoE) nor clear guidance on the comparative effectiveness of various delivery methods of topical steroids. To address these uncertainties, investigators conducted a comprehensive review and network meta-analysis comparing the efficacy of proton pump inhibitors, EoE-specific and off-label topical steroids, and biologics in achieving histologic remission, symptomatic response, or endoscopic response.

Of 17 randomized controlled trials (RCTs) reviewed, 15 studies comprising 1813 total individuals with EoE provided relevant data for the network meta-analysis. Lirentelimab at a dose of 1 mg/kg per month ranked highest for achieving histologic remission, defined as ≤6 eosinophils/high-power field (HPF), while budesonide orally disintegrating tablet (BOT) at a dose of 1 mg twice daily ranked first for histologic remission, defined as ≤15 eosinophils/HPF. Notably, BOT and budesonide oral suspension (BOS) taken twice a day at 1-mg and 2-mg doses, respectively, demonstrated significant efficacy over placebo in preventing failure to achieve symptom improvement. Additionally, a 1-mg dose of BOT twice a day and 1-mg or 2-mg doses of BOS twice daily showed greater efficacy than placebo in preventing failure to achieve endoscopic improvement according to the EoE Endoscopic Reference Score.