Viscous budesonide ranks as most effective therapy for EoE in meta-analysis
Viscous budesonide appears to be the most effective pharmacologic therapy for eosinophilic esophagitis (EoE) among several pharmacologic treatments, including budesonide suspension, fluticasone, prednisone, esomeprazole and mepolizumab, according to the results of a network meta-analysis.
Researchers searched multiple electronic databases for studies evaluating pharmacologic treatments for EoE and performed a random-effects network meta-analysis to identify the most effective therapy, with the ranking probability for the efficacy of each treatment analysed. A subgroup analysis was also carried out among studies that excluded gastroesophageal reflux disease or proton pump inhibitor therapy-responsive oesophageal eosinophilia, and among studies conducted in paediatric and adult populations.
A total of 11 studies involving 456 patients and comparing six pharmacologic treatments (budesonide suspension and viscous, fluticasone, prednisone, esomeprazole, and mepolizumab) against placebo were included in the analysis.
Pooled data demonstrated the superiority of budesonide viscous, budesonide suspension and fluticasone over placebo. The rank order of efficacy among the reported pharmacologic treatments was as follows: budesonide viscous, esomeprazole, prednisone, budesonide suspension, fluticasone, mepolizumab and placebo.
Results were robust on inconsistency model analysis and node-splitting analysis.
In the subgroup analysis, prednisone was the most effective among studies that excluded gastroesophageal reflux disease or proton pump inhibitor-responsive oesophageal eosinophilia. On the other hand, budesonide suspension and esomeprazole were the most effective pharmacologic treatments and among studies in paediatric and adult populations, respectively.
Additional comparative studies, especially among different topical steroid therapies, are warranted to confirm the present data, researchers said.