S477 A Real World Study of Cumulative Steroid Burden in Patients With Newly Diagnosed Eosinophilic Esophagitis

Abstract

Introduction: Patients with eosinophilic esophagitis (EoE) are at risk for long-term corticosteroid (CS) exposure as swallowed topical CSs (STCs) are routinely prescribed as a treatment. Further, the prevalent type 2 comorbidities (such as asthma) in EoE patients may also be treated with CSs. However, real-world burden of long-term use of STCs in EoE patients is not well documented. The aim of this study is to describe the cumulative CS burden in newly diagnosed EoE patients compared to a general patient population. Methods: In this retrospective analysis of the US Optum Clinformatics Data Mart (2007–2019), eligible patients had ≥2 claims (≥30 to ≤365 days apart) with an EoE diagnosis and ≥1y of continuous enrollment (up to 31-day allowable gap) before the index date (first claim of EoE diagnosis). The matched (1:1 on age, sex, and history of asthma) patients without EoE met same enrollment and inclusion criteria on the EoE patient’s index date. Demographics were extracted in 1-y preindex period, and treatment history with systemic (SCS), oral (OCS), or inhaled CS (ICS) was identified by National Drug Codes. All-cause CSs use was measured at the follow-up starting at the index date and ending at disenrollment or the end of the study. Results: Overall, 17,777 patients with EoE (3095 1–17y old and 14,682 ≥18y old) were matched with 17,777 patients from a general population (3017 1–17y old and 14,760 ≥18y old) (Table). At baseline, patients with EoE across age groups had significantly (P< 0.01) higher exposure to CSs and a longer treatment duration than the matched patients (Table). In the follow-up, the exposure to SCS, OCS, and ICS was significantly (P< 0.01) higher in 1–17y old EoE patients (difference: 23.5%, 13.3%, and 51.6%, respectively) and ≥18y old EoE patients (difference: 13.8%, 10.2%, and 36.6%, respectively) than the matched patients (Figure). The mean annualized treatment duration with CSs was also significantly (P< 0.01) longer in EoE patients across all age groups versus matched patients (Figure). Conclusion: This study demonstrated that patients with EoE across all age groups had considerably more prescriptions, cumulative exposure, and treatment duration of SCS, OCS, and ICS than a matched general patient population. Prior and current exposure to CSs should be considered while prescribing CSs to EoE patients across all age groups, particularly pediatric patients, as they have increased likelihood of additional exposure throughout their lifespan.Figure 1.: (a) Cumulative Steroid Exposure and (b) Annualized Steroid Treatment Duration in Patients with EoE and Matched General Population During Follow-up. EoE, eosinophilic esophagitis; ICS, inhaled corticosteroid; OCS, oral corticosteroid; SCS, systemic corticosteroid; SD, standard deviation. *P<0.01. #The cumulative dose was calculated as the sum of the total dose for all dispensed prescriptions included in the drug class over the assessment period. $Oral and parenteral corticosteroids. Table 1. - Baseline Demographic and Clinical Characteristics of Patients with EoE and Matched General Population. Characteristics Aged 1–17y Aged ≥18y Patients with EoE Matched control patients Patients with EoE Matched control patients Number of patients 3095 3017 14682 14760 Age: mean years (SD) 10.01 (4.84) 10.18 (4.76) 45.02 (15.18) 45.25 (15.27) Female; n (%) 898 (29.0) 866 (28.7) 5567 (37.9) 5599 (37.9) Race/Ethnicity; n (%) Asian 110 (3.6) 173 (5.7) 264 (1.8) 842 (5.7) Black 167 (5.4) 263 (8.7) 726 (4.9) 1436 (9.7) White 2399 (77.5) 1976 (65.5) 12420 (84.6) 9977 (67.6) Hispanic 180 (5.8) 368 (12.2) 718 (4.9) 1821 (12.3) Unknown/Missing 239 (7.7) 237 (7.9) 554 (3.8) 684 (4.6) Type II comorbidities; n (%) Asthma 822 (26.6) 807 (26.7) 1666 (11.3) 1681 (11.4) Person years of follow-up; mean (SD) 2.91 (2.38) 2.73 (2.41) 2.61 (2.08) 2.42 (2.06) Cumulative# corticosteroid exposure; n (%) Systemic (SCS)$ 840 (27.1) 577 (19.1) 3983 (27.1) 3065 (20.8) Oral (OCS) 653 (21.1) 526 (17.4) 2719 (18.5) 2078 (14.1) Inhaled (ICS) 754 (24.4) 344 (11.4) 1309 (8.9) 343 (2.3) Annualized corticosteroid treatment duration; mean days, (SD) SCS$ 3.82 (20.07) 2.04 (12.45) 4.08 (23.01) 2.92 (19.14) OCS 3.82 (20.07) 2.03 (12.43) 4.02 (22.99) 2.88 (19.11) ICS 21.88 (56.36) 9.37 (35.66) 6.17 (30.12) 2.21 (19.89) EoE, eosinophilic esophagitis; ICS, inhaled corticosteroid; OCS, oral corticosteroid; SCS, systemic corticosteroid; SD, standard deviation.#The cumulative dose was calculated as the sum of the total dose for all dispensed prescriptions included in the drug class over the assessment period.$Oral and parenteral corticosteroids.