Which treatment is optimal for eosinophilic oesophagitis?

A twice-daily dose of 1-mg budesonide orodispersible tablets appears to be the most effective treatment for eosinophilic oesophagitis (EoE), results of a network meta-analysis have shown.

“This treatment remained the optimal approach in adult patients, whereas fluticasone was the best treatment in paediatric patients,” the investigators said.

The comparative efficacy of various treatments for EoE were assessed in this network meta-analysis. The investigators combined direct and indirect data to examine the efficiency of drug therapies, which were evaluated in relevant randomized controlled trials for EoE.

Of the 17 studies that met the eligibility criteria, 14 were two-arm and three were multiple-arm. Fifteen therapeutic interventions for EoE were used in a total of 1,011 patients, including: (1) budesonide oral suspension, (2) budesonide 1 mg orodispersible tablet twice daily, (3) budesonide 2 mg orodispersible tablet twice daily, (4) esomeprazole, (5) fluticasone, (6) nebulized steroid, (7) placebo, (8) prednisone, (9) anti-IL-5-mab (mepolizumab), (10) anti-IL-5-mab (reslizumab 1 mg/kg), (11) anti-IL-5-mab (reslizumab 2 mg/kg), (12) anti-IL-5-mab (reslizumab 3 mg/kg), (13) anti-IL-13-mab (QAX 576), (14) anti-IL-13-mab (RCP 4046 [180]), and (15) anti-IL-13-mab (RCP 4046 [360]).

Budesonide 1 mg orodispersible tablet twice daily was found to have the highest efficacy (surface under cumulative ranking, 0.91), while placebo had the lowest. Budesonide 1 mg orodispersible tablet twice daily remained the best treatment approach in adult patients; in paediatric patients, fluticasone appeared to be the optimal therapeutic approach.

“Network meta-analysis is used as a data synthesizer, incorporating direct and indirect evidence about treatments in a series of randomized control trials,” the investigators noted.