Esophagus to Small Intestine

Gut. 2023;72(11):2019–30

Visaggi P, Barberio B, Del Corso G, de Bortoli N, Black CJ, Ford AC, Savarino E

Comparison of drugs for active eosinophilic esophagitis: Systematic review and network meta-analysis

Background: There is currently no recommendation regarding preferred drugs for active eosinophilic esophagitis (EoE) because their relative efficacy is unclear. The authors conducted an up-to-date network meta-analysis to compare proton-pump inhibitors, off-label and EoE-specific topical steroids, and biologics in EoE.
Methods: They searched Medline, Embase, Embase Classic and the Cochrane Central Register of Controlled Trials from inception to June 2023, and included randomized controlled trials (RCTs) comparing efficacy of all drugs versus each other, or placebo, in adults and adolescents with active EoE. Results were reported as pooled relative risks with 95% confidence intervals [CIs] to summarize effect of each comparison tested, with drugs ranked according to p score.
Results: 17 RCTs were eligible for systematic review. Of these, 15 studies containing 1813 subjects with EoE reported extractable data for the network meta-analysis. For histological remission defined as ≤ 6 eosinophils/high-power field (eos/hpf), lirentelimab 1 mg/kg monthly ranked first. For histological remission defined as ≤ 15 eos/hpf, budesonide orally disintegrating tablet (BOT) 2 x 1 mg/day ranked first. For failure to achieve symptom improvement, BOT 2 x 1 mg/day and budesonide oral suspension (BOS) 2 x 2 mg/day were significantly more efficacious than placebo. For failure to achieve endoscopic improvement based on the EoE Endoscopic Reference Score, BOT 2 x 1 mg/day and BOS 2 x 1 mg/day or 2 x 2 mg/day were significantly more efficacious than placebo. C

onclusions: Although this network meta-analysis supports the efficacy of most available drugs over placebo for treatment of eosinophilic esophagitis, significant heterogeneity in eligibility criteria and outcome measures among available trials hampers the establishment of a solid therapeutic hierarchy.

Prof. Dr. E. Savarino, Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy, E-Mail:

DOI: 10.1136/gutjnl-2023-329873

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