Viscous Topical Is More Effective Than Nebulized Steroid Therapy for Patients With Eosinophilic Esophagitis

We performed a randomized trial to compare nebulized and viscous topical corticosteroid treatments for eosinophilic esophagitis (EoE). Subjects with incident EoE (n = 25) received budesonide 1 mg twice daily, either nebulized and then swallowed (NEB) or as an oral viscous slurry (OVB), for 8 weeks....

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Bibliographic Details
Published in:	Gastroenterology (New York, N.Y. 1943) Vol. 143; no. 2; pp. 321 - 324.e1
Main Authors:	Dellon, Evan S, Sheikh, Arif, Speck, Olga, Woodward, Kimberly, Whitlow, Ann B, Hores, Jessica M, Ivanovic, Marija, Chau, Allen, Woosley, John T, Madanick, Ryan D, Orlando, Roy C, Shaheen, Nicholas J
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-08-2012
Subjects:	Administration, Oral Administration, Topical Adult Biomarkers - metabolism Budesonide - administration & dosage Budesonide - pharmacokinetics Budesonide - therapeutic use Clinical Trial Corticosteroid Drug Administration Schedule Eosinophilic Esophagitis - diagnostic imaging Eosinophilic Esophagitis - drug therapy Eosinophilic Esophagitis - metabolism Eosinophils - metabolism Esophagus Esophagus - diagnostic imaging Esophagus - metabolism Female Gastroenterology and Hepatology Glucocorticoids - administration & dosage Glucocorticoids - pharmacokinetics Glucocorticoids - therapeutic use Humans Inflammation Leukocyte Count Male Oral Sprays Prospective Studies Radionuclide Imaging Treatment Outcome Corticosteroid RCT oral viscous/swallowed budesonide Clinical Trial nebulized/swallowed budesonide Inflammation NEB area under the curve Esophagus AUC randomized controlled trial eosinophilic esophagitis EoE OVB
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Summary:	We performed a randomized trial to compare nebulized and viscous topical corticosteroid treatments for eosinophilic esophagitis (EoE). Subjects with incident EoE (n = 25) received budesonide 1 mg twice daily, either nebulized and then swallowed (NEB) or as an oral viscous slurry (OVB), for 8 weeks. Baseline eosinophil counts for the NEB and OVB groups were 101 and 83 ( P = .62). Posttreatment counts were 89 and 11 ( P = .02). The mucosal medication contact time, measured by scintigraphy, was higher for the OVB group than the NEB group ( P < .005) and was inversely correlated with eosinophil count ( R = −0.67; P = .001). OVB was more effective than NEB in reducing numbers of esophageal eosinophils in patients with EoE. OVB provided a significantly higher level of esophageal exposure to the therapeutic agent, which correlated with lower eosinophil counts.
ISSN:	0016-5085 1528-0012
DOI:	10.1053/j.gastro.2012.04.049