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Miehlke S, Schlag C, Lucendo AJ, Biedermann L, Vaquero CS, Schmoecker C, Hayat J, Hruz P, Ciriza de Los Rios C, Bredenoord AJ, Vieth M, Schoepfer A, Attwood S, Mueller R, Burrack S, Greinwald R, Straumann A. Budesonide orodispersible tablets for induction of remission in patients with active eosinophilic oesophagitis: A 6-week open-label trial of the EOS-2 Programme. United European Gastroenterol J 2022; 10:330-343. [PMID: 35412032 PMCID: PMC9004242 DOI: 10.1002/ueg2.12220] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/15/2022] [Indexed: 11/27/2022] Open
Abstract
Background A novel budesonide orodispersible tablet (BOT) has been proven effective in adult patients with active eosinophilic oesophagitis (EoE) in a 6‐week placebo‐controlled trial (EOS‐1). Aims To report the efficacy of an open‐label induction treatment with BOT in a large prospective cohort of EoE patients within the EOS‐2 study. Methods Patients with clinico‐histological active EoE were treated with BOT 1 mg BID for 6 weeks. The primary endpoint was clinico‐histological remission (≤2 points on numerical rating scales [0–10] each for dysphagia and odynophagia, and peak eosinophil count <16 eos/mm2 hpf (corresponds to <5 eos/hpf)). Further study endpoints included clinical and histological remission rates, change in the EEsAI‐PRO score, change in peak eosinophil counts, and deep endoscopic remission using a modified Endoscopic Reference Score. Results Among 181 patients enrolled, 126 (69.6%) achieved clinico‐histological remission (histological remission 90.1%, clinical remission 75.1%). The mean peak eosinophil counts decreased by 283 eos/mm2 hpf (i.e., by 89.0%). Mean EEsAI‐PRO score decreased from baseline by 29 points and deep endoscopic remission was achieved in 97 (53.6%) patients. The majority of patients judged tolerability as good or very good (85.6%) and compliance was high (96.5%). Local candidiasis was suspected in 8.3% of patients; all were of mild severity, resolved with treatment and none led to premature withdrawal from the study. Conclusions In this large prospective trial, a 6‐week open‐label treatment with BOT 1 mg BID was highly effective and safe in achieving clinico‐histological remission of active EoE and confirmed the results of the placebo‐controlled EOS‐1 trial.
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Affiliation(s)
- Stephan Miehlke
- Centre for Digestive Diseases, Internal Medicine Centre Eppendorf, Hamburg, Germany.,Centre for Oesophageal Disorders, University Hospital Eppendorf, Hamburg, Germany
| | - Christoph Schlag
- II. Medizinische Klinik, Klinikum rechts der Isar, TU München, München, Germany
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.,Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Cecilio Santander Vaquero
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.,Instituto de Investigación Sanitaria Princesa, Madrid, Spain.,Department of Gastroenterology and Hepatology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Christoph Schmoecker
- Klinik für Innere Medizin 1, Sana Klinikum Lichtenberg, Berlin, Germany.,Medizinische Hochschule Brandenburg, Campus Ruppiner Kliniken, Medizinische Klinik B, Neuruppin, Germany
| | - Jamal Hayat
- Department of Gastroenterology, Saint George's University Hospitals NHS Trust, London, UK
| | - Petr Hruz
- Clarunis, University Centre for Liver and Gastrointestinal Diseases, St. Clara Hospital and University Hospital Basel, Basel, Switzerland
| | | | - Albert Jan Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Michael Vieth
- Institute for Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Klinikum Bayreuth, Bayreuth, Germany
| | - Alain Schoepfer
- Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Stephen Attwood
- Department of Health Services Research, Durham University, Durham, UK
| | - Ralph Mueller
- Department of Clinical Research & Development, Dr. Falk Pharma GmbH, Freiburg, Germany
| | - Sarah Burrack
- Department of Clinical Research & Development, Dr. Falk Pharma GmbH, Freiburg, Germany
| | - Roland Greinwald
- Department of Clinical Research & Development, Dr. Falk Pharma GmbH, Freiburg, Germany
| | - Alex Straumann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.,Swiss EoE Research Group, Olten, Switzerland
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Straumann A, Lucendo AJ, Miehlke S, Vieth M, Schlag C, Biedermann L, Vaquero CS, Ciriza de Los Rios C, Schmoecker C, Madisch A, Hruz P, Hayat J, von Arnim U, Bredenoord AJ, Schubert S, Mueller R, Greinwald R, Schoepfer A, Attwood S, Miehlke S, Bajbouj M, Brückner S, Fibbe C, Haag S, Schmöcker C, Hartmann D, Lammert F, Madisch A, Reinshagen M, Schubert S, von Arnim U, Börner N, Witzemann D, Caca K, Albert J, Zeuzem S, Wiedbrauck F, Messmann H, Bredenoord AJ, Verdonk R, Wolfhagen F, Villarin AL, Vaquero CS, de los Ríos CC, Juan AP, Martinez IP, Sanchez-Migallon JR, Andrés JB, Aisa Á, Straumann A, Hruz P, Schoepfer A, Biedermann L, Hayat J, Dhar A. Budesonide Orodispersible Tablets Maintain Remission in a Randomized, Placebo-Controlled Trial of Patients With Eosinophilic Esophagitis. Gastroenterology 2020; 159:1672-1685.e5. [PMID: 32721437 DOI: 10.1053/j.gastro.2020.07.039] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder. Swallowed topical-acting corticosteroids are effective in bringing active EoE into remission. However, it is not clear whether these drugs are effective for long-term maintenance of remission. METHODS We performed a double-blind trial to compare the efficacy and safety of 2 dosages of a budesonide orodispersible tablet (BOT) vs placebo in maintaining remission of EoE. Maintenance of remission was defined as absence of clinical and histologic relapse and no premature withdrawal for any reason. Two hundred and four adults with EoE in clinical and histologic remission, from 29 European study sites, were randomly assigned to groups given BOT 0.5 mg twice daily (n = 68), BOT 1.0 mg twice daily (n = 68), or placebo twice daily (n = 68) for up to 48 weeks. RESULTS At end of treatment, 73.5% of patients receiving BOT 0.5 mg twice daily and 75% receiving BOT 1.0 mg twice daily were in persistent remission compared with 4.4% of patients in the placebo group (P < .001 for both comparisons of BOT with placebo). Median time to relapse in the placebo group was 87 days. The frequency of adverse events was similar in the BOT and placebo groups. Morning serum levels of cortisol were in the normal range at baseline and did not significantly change during treatment. Four patients receiving BOT developed asymptomatic, low serum levels of cortisol. Clinically manifested candidiasis was suspected in 16.2% of patients in the BOT 0.5 mg group and in 11.8% of patients in the BOT 1.0 mg group; all infections resolved with treatment. CONCLUSIONS In a phase 3 trial, up to 48 weeks of treatment with BOT (0.5 mg or 1.0 mg twice daily) was superior to placebo in maintaining remission of EoE. Both dosages were equally effective and well tolerated. EudraCT number; 2014-001485-99; ClinicalTrials.gov number, NCT02434029.
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Affiliation(s)
- Alex Straumann
- Swiss Eosinophilic Esophagitis Research Group, Olten, Switzerland; Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain; Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | - Stephan Miehlke
- Center for Digestive Diseases, Internal Medicine Center Eppendorf, Hamburg, Germany; Center for Esophageal Disorders, University Hospital Hamburg-Eppendorf, Germany
| | - Michael Vieth
- Institute for Pathology, Klinikum Bayreuth, Bayreuth, Germany
| | - Christoph Schlag
- II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Luc Biedermann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Cecilio Santander Vaquero
- Centro de Investigación Biomédica en Red en Enfermedades Hepáticas y Digestivas, Madrid, Spain; Instituto de Investigación Sanitaria Princesa, Madrid, Spain; Servicio de Aparato Digestivo, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | - Ahmed Madisch
- Department of Gastroenterology, Clinical-Center Region Hannover Clinic Siloah, Hannover, Germany
| | - Petr Hruz
- Department of Gastroenterology, University Hospital Basel, Basel, Switzerland
| | - Jamal Hayat
- Department of Gastroenterology, Saint George's University Hospitals National Health Service Trust, London, UK
| | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Albert Jan Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center Amsterdam, Amsterdam, the Netherlands
| | | | - Ralph Mueller
- Department of Clinical Research and Development, Dr Falk Pharma GmbH, Freiburg, Germany
| | - Roland Greinwald
- Department of Clinical Research and Development, Dr Falk Pharma GmbH, Freiburg, Germany
| | - Alain Schoepfer
- Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Stephen Attwood
- Department of Health Services Research, Durham University, Durham, UK
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