PGI27 Systematic Review and Network Meta-Analysis: Topical Corticosteroids for Inducing Histological Remission in Eosinophilic Oesophagitis

Abstract

Topical corticosteroids, comprised mainly of fluticasone multi-dose inhaler content swallowed or budesonide viscous solution (BVS), are the foundation of treatment for eosinophilic oesophagitis (EoE). Recently, a budesonide orodispersible tablet (BOT) has been approved for the treatment of EoE. Given the absence of direct comparisons, we evaluated the relative efficacy of BOT with other topical corticosteroid formulations for inducing histological remission in patients with EoE by a network meta-analysis (NMA). A systematic literature review was performed using MEDLINE and Embase up to August 1, 2019. Eligible studies comprised randomised controlled trials (RCTs) which evaluated adult patients with a diagnosis of active EoE treated with a topical corticosteroid in comparison to placebo or another topical corticosteroid. The outcome of interest was the proportion of patients achieving induction of histological remission defined as a peak oesophageal eosinophil count of <5 eosinophils/high-power field. Direct comparisons were made using the Mantel-Haenszel method and an NMA was performed using a fixed effects Bayesian framework with Markov Chain Monte Carlo simulations. A total of 6 trials (n=447 patients) were included in the quantitative summary. The NMA determined that BOT was associated with a higher odds of histological remission compared to BVS (odds ratio [OR]=4.9 [95% credible interval [CrI]=1.4, 19.1]), fluticasone (7.4 [1.7, 34.5]), nebulised swallowed budesonide (NSB) (25.0 [2.9, 247.2]) and placebo (387.6 [97.5, 2,275.6]). Similar findings were observed for direct comparisons. This NMA of RCTs suggest that BOT is significantly more likely to achieve histological remission in adult patients with EoE compared to BVS, fluticasone, and NSB.