Swallowed topical steroid maintenance therapy for eosinophilic esophagitis: A systematic review and meta-analysis
Abstract
BACKGROUND
Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder presenting as symptoms of dysphagia, esophageal food impaction, chest pain, and heartburn. After an initial trial of proton pump inhibitor (PPI) therapy, swallowed topical corticosteroids (STC) are effective as induction therapy for EoE. However, outcome data for STC as a maintenance strategy is limited.
AIM
To systematically evaluate the long-term outcomes and safety of maintenance treatment with STC.
METHODS
A systematic search of PubMed, EMBASE, Cochrane, and Web of Science was performed from inception to January 2025 for studies comparing long term or maintenance treatment with STC for EoE compared to placebo. We included studies that investigated patients who underwent successful induction therapy. Pooled data was analyzed for histologic recurrence, symptom recurrence, need for repeat esophageal dilation, use of concomitant PPI, and candida infection rates. A random effects model was used, and the data was presented using odds ratios (OR) with 95% confidence intervals (CI).
RESULTS
Three randomized control trials and one observational study were included, involving 303 patients (189 in the STC group, 114 in the placebo-controlled group). Analysis showed that histologic recurrence was significantly lower with STC (OR: 0.04, 95%CI: 0.01-0.28, P < 0.00001, I 2 = 78%). Overall symptom recurrence was similar between groups (OR: 0.23, 95%CI: 0.02-3.54, P = 0.29, I 2 = 92%). On sensitivity analysis,…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 303 participants or records.
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