S456 Physician-Documented Symptoms and Treatment Among Patients With Eosinophilic Esophagitis in the United States: Evidence From Real World Clinical Practice

Abstract

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disorder of the esophagus that is associated with significant patient burden and upper gastrointestinal morbidity. Typical EoE symptoms include dysphagia, food impaction, abdominal pain, and nausea, and symptoms may persist regardless of current standard of care treatments, ultimately affecting health-related quality of life (HRQoL). This real-world study characterizes physician-documented symptoms and treatments among US patients with EoE. Methods: Adelphi Real World Disease Specific Programmes (DSPs) are multinational, point-in-time surveys providing data regarding real-world clinical practice. The present study is an analysis of surveys completed by gastroenterologists and allergists managing patients with EoE that were collected as part of the Adelphi EoE DSP in 2020 in the United States. Patients were included if they were age ≥12 years with a physician-confirmed diagnosis of EoE (esophageal count of ≥15 eosinophils/high power field) and currently receiving prescribed treatment for EoE; a subset of patients currently experiencing dysphagia was also evaluated. Results: A total of 322 US patients with EoE were assessed; among these, 113 (35%) currently had dysphagia. Overall, the mean age was 35.6 years and 63% were male. The average time since diagnosis was 28 months, and 20% switched their treatments. The main reasons for current treatment were for symptomatic relief and to improve HRQoL. Treatments are summarized in the Table. Despite 83% of patients being mostly/completely adherent to treatment, patients were still burdened with symptoms such as reflux (38%), dysphagia (35%), and heartburn (26%). Almost half of patients were either currently on an elimination (27%) or elemental diet (3%; for an average of 61 weeks), or previously had attempted an elimination (21%) or elemental diet (4%). Further, 30% of patients had undergone esophageal dilation (23% after admission to the hospital or emergency room), with a mean of 1.5 dilations since diagnosis. Patients with dysphagia (n=113) had similar treatment (Table) and adherence (77% mostly/completely adherent) patterns but more often had undergone dilation (36%). Conclusion: Despite good adherence with current PPIs and/or corticosteroids, many patients with EoE are still experiencing symptoms, implementing dietary interventions, and undergoing dilations, highlighting a need for new targeted therapies. Table 1. - Treatments for eosinophilic esophagitis in the United States All patients All patients All patients Patients with dysphagia Patients with dysphagia Patients with dysphagia Previous a (n=63) Current (n=322) Duration b (months) Previous a (n=30) Current (n=113) Duration b (months) PPI 60% 87% 21.6 60% 86% 15.9 Corticosteroids TCS 35% 37% 20.3 27% 45% 12.9 OCS 6% 5% 30.6 7% 4% 25.2 Other 29% 19% 19.0 37% 20% 12.0 Antihistamines 13% 17% 28.8 13% 12% 19.1 Antileukotrienes 5% 6% 33.0 0% 2% 4.3 Biologics 0% 1% 29.6 0% 1% 48.0 aPrevious patients were those who switched treatments.bDurations are for current use only.OCS, oral corticosteroids; PPI, proton pump inhibitor; TCS, topical corticosteroids.