Researchers Reexamine Budesonide for EoE in Meta-Analysis

Budesonide is recommended as one of the first-line drugs for treatment of eosinophilic esophagitis (EoE), a chronic immune-mediated inflammatory disease, and in a recent study researchers updated a meta-analysis using randomized controlled trial results (RCTs) to confirm its efficacy and safety.

Common treatments for EoE include drug therapy, such as budesonide, fluticasone propionate, proton pump inhibitors (PPI), and dupilumab; food-restricted diets; and esophageal dilatation.

There is no consensus on the standardized use of budesonide for EoE treatment, given the variety of populations studied, administration method, dose, and other factors, according to the authors. It is used to inhibit esophageal epithelial inflammation, repair the mucosal barrier, and promote tissue remodeling.

A 2015 meta-analysis based on trials including but not limited to RCTs showed that steroids can effectively reduce the eosinophil count of EoE patients, but their values in improving symptoms have not been determined.

A 2016 meta-analysis report based on RCTs showed that corticosteroids had an effect on histology, but not in relief of clinical symptoms.

The authors said given that more recently more high-quality RCTs have been published recently, it was valuable to conduct another review in order to include these more recent studies.

RCT literature from 2000 to June 20, 2021, on using budesonide for EoE was retrieved from 3 databases: PubMed, Embase, and Cochrane.

Out of 958 articles, 10 were included in the final analysis, creating a sample size of 712 cases. All 10 compared treatment with budesonide to a placebo.

Patients in the budesonide group achieved better histological remission (RR = 23.82; 95% CI, 13.46-42.21; P < .001); as well as reduced eosinophil counts (SMD = -1.34; 95% CI = (-1.52, -1.15), P < .001) as compared with placebo.

"Mounting high-quality RCTs have confirmed the efficacy of oral budesonide in the treatment of eosinophilic esophagitis and that the effects of this drug may not be so dose-dependent," the researchers reported, adding that the drug is safe to take for a long interval.

They wrote that 0.5–1.0 mg twice daily given orally administration can be used as the recommended dose. They suggested that further research with larhger sample sizees is needed.

Reference

Liu X, Xiao X, Liu D, Tan C. A meta-analysis on randomized controlled trials of treating eosinophilic esophagitis with budesonide. Ann Med. 2022 Dec;54(1):2078-2088. doi: 10.1080/07853890.2022.2101689.