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Clinical features, biomarkers predicted steroid response in EoE
Need for esophageal dilation at baseline, abdominal pain at presentation and high esophageal tissue levels of eotaxin-3 and tryptase predicted response to topical corticosteroids in patients with eosinophilic esophagitis, according to new research data.
W. Asher Wolf
W. Asher Wolf, MD, MPH, and Evan S. Dellon, MD, MPH, from the University of North Carolina School of Medicine, and colleagues conducted a retrospective cohort study of 221 patients (mean age, 25.6 years; 83% white; 70% men) treated with swallowed topical corticosteroids for eosinophilic esophagitis (EoE) at University of North Carolina Hospitals from 2006 to 2013. Patient data was obtained from electronic records, and archived biopsies were immunohistochemically analyzed for major basic protein, eotaxin-3 and tryptase on a random subset (n=40).
Endoscopic improvement after steroid therapy was observed in 71% of patients, 79% had symptomatic improvement, and 57% responded histologically (<15 eosinophils/high-power field). After adjusting for age, allergic disease and baseline eosinophil count, baseline esophageal dilation predicted nonresponse to steroid therapy (OR=2.9; 95% CI, 1.4-6.3), and abdominal pain at presentation predicted steroid-response (nonresponse; OR=0.31; 95% CI, 0.12-0.83). Higher levels of tryptase (P=.04) and eotaxin-3 (P=.02) also predicted steroid response.
Evan S. Dellon
“While the majority of patients benefited from topical steroid therapy, nonresponse was common,” the researchers concluded. “There were few clinical, endoscopic, or histologic predictors of nonresponse, but the need for dilation at baseline was a strong independent predictor. Additionally, high esophageal tissue levels of eotaxin-3 and mast cells at baseline predicted treatment response, but this intriguing finding requires prospective confirmation before it can be adopted clinically.”
Disclosure: Evan S. Dellon, MD, MPH, has received research funding from AstraZeneca and Meritage, and is a consultant for Aptalsis, Novartis, Receptos and Regeneron.