368 Comparison of Budesonide and Fluticasone in the Treatment of Patients With Eosinophilic Esophagitis: A Systematic Review and Meta-Analysis

Abstract

INTRODUCTION: Steroids are the first line treatment of choice in patients with eosinophilic esophagitis (EOE) who failed proton pump inhibitors (PPIs). Fluticasone and budesonide are the two main steroid medications used in EOE treatment, but current guidelines do not recommend one agent over the other. In our study, we aim to conduct a meta-analysis to compare both agents and determine whether if one agent is associated with better outcomes. METHODS: A comprehensive search of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Scopus was performed from each database’s inception to June, 1st, 2019. Two independent reviewers systematically identified trials that compared the effect of budesonide versus fluticasone in the management of EOE. A meta-analysis was performed using a fixed effects model. The main outcome was the histologic response (defined as eosinophils count < 15/HPF), and therefore response to treatment. RESULTS: Three studies met our inclusion criteria and included in the analysis, with a total of 272 patients. All studies were done in the United States, with one RCT. Our meta-analysis showed no statistically significant difference with the use of budesonide compared to fluticasone in achieving histologic response (total of eosionphils count < 15/hpf) (OR: 1.29, 95% CI: 0.77-2.14, P = 0.34, heterogeneity I2: 0%). CONCLUSION: Our systematic review and meta-analysis indicated no difference in budesonide and fluticasone in achieving histologic response in patients with eosinophilic esophagitis.