Introduction
Eosinophilic oesophagitis (EoE) is a chronic progressive type 2 inflammatory disease clinically characterized by oesophageal dysfunction symptoms (dysphagia, food impaction, odynophagia, chest discomfort) and histologically by eosinophil predominance.1-3 The global incidence and prevalence of EoE are increasing; therefore, real-world data can aid in identifying current disease management challenges.
Aims & Methods
Aim: This study aimed to describe demographics, clinical features, treatment patterns, health outcomes, and healthcare resource utilization (HCRU) among real-world patients with EoE.
Methods: We analysed medical record data collected from a multinational cohort of EoE patients diagnosed between January 1, 2009, and December 31, 2019. Physicians from Canada, France, Germany, Spain, and the United Kingdom provided data for eligible patients aged ≥12 years with an eosinophil (eos) count ≥15 eos/hpf within 90 days of diagnosis and at least one follow-up endoscopy within 24 months. We collected data on patient demographics, clinical characteristics, treatment patterns, outcomes, and HCRU. Patients were followed until their last medical record entry or death, whichever occurred first. Outcomes are from three-year follow-up period from the index date. Descriptive statistics were employed to estimate continuous variables and categorical variables.
Results
This study included 415 patients diagnosed with EoE, with a mean age of 31.8 ± 14.6 years. The majority of patients were white (91.8%) and male (74.0%). The average (±SD) follow-up duration was 5.2 (±3.2) years post-EoE diagnosis. The mean (±SD) delay between symptom onset and the diagnosis was 3.4 (±4.8) years. At EoE diagnosis, the mean (±SD) peak eosinophil count was 41.4 (±43.4) eos/hpf and endoscopic abnormalities were found in 80.2% of patients. After EoE diagnosis, patients were treated with proton pump inhibitors (PPIs) (77.1%), swallowed topical corticosteroids (STCs) (68.2%), dietary modifications (48.4%), oesophageal dilation (18.8%), and systemic corticosteroids (10.8%). At third-year follow-up (n = 392), patients continued to experience dyspepsia (20.4%), heartburn (23.5%), dysphagia (24.5%), and food impaction (5.4%) despite treatment. A relatively small percentage of patients achieved histologic remission during the first 5 years after EoE diagnosis; 4.1% with ≤1 eos/hpf (mean time to histologic remission [±SD]: 2.0 [±1.3] years), 20.0% with ≤6 eos/hpf (1.5 [±1.2] years), and 42.4% with <15 eos/hpf (1.4 [±1.1] years). During follow-ups, 98.8% (first year) and 97.3% (third year) of patients had at least one office visit, and 39.9% (first year) and 25.6% (third year) had at least one consultation with an allergist/immunologist.
Table 1. Overview of treatment patterns after eosinophilic oesophagitis diagnosis
| All countries
(N = 415) | United Kingdom
(N = 93) | Germany
(N = 96) | Spain
(N = 97) | France
(N = 99) | Canada
(N = 30) |
| Dietary modification or elimination | 201 | 48.4% | 41 | 44.1% | 53 | 55.2% | 46 | 47.4% | 41 | 41.4% | 20 | 66.7% |
| Oesophageal dilation | 78 | 18.8% | 10 | 10.8% | 20 | 20.8% | 21 | 21.7% | 16 | 16.2% | 11 | 36.7% |
| Proton pump inhibitors | 320 | 77.1% | 62 | 66.7% | 59 | 61.5% | 89 | 91.8% | 87 | 87.9% | 23 | 76.7% |
| Swallowed topical corticosteroids (e.g., preparations of fluticasone, budesonide) | 283 | 68.2% | 55 | 59.1% | 79 | 82.3% | 55 | 56.7% | 76 | 76.8% | 18 | 60.0% |
| Systemic (i.e., oral) corticosteroids | 45 | 10.8% | 4 | 4.3% | 24 | 25.0% | 8 | 8.3% | 7 | 7.1% | 2 | 6.7% |
Conclusion
This study highlights a significant delay in diagnosing EoE from the onset of symptoms. Along with PPIs and dietary modifications, a high percentage of patients received STCs and oesophageal dilation, indicating a substantial burden. Despite these treatments, optimal histologic remission rates and symptomatic control remain unmet needs. Addressing EoE burden necessitates developing strategies for earlier diagnosis and additional therapies to improve long-term management.
References
- Mansoor E, Cooper GS. The 2010-2015 Prevalence of Eosinophilic Esophagitis in the USA: A Population-Based Study. Dig Dis Sci. 2016;61(10):2928-2934. doi:10.1007/s10620-016-4204-4.
- Lu M, Goodwin B, Vera-Llonch M, Williams J. Disease Burden and Treatment Patterns Associated With Eosinophilic Esophagitis in the United States: A Retrospective Claims Study. J Clin Gastroenterol. 2022 Feb 1;56(2):133-140. doi: 10.1097/MCG.0000000000001491. PMID: 33443967; PMCID: PMC8754098.
- Katzka DA. Eosinophilic Esophagitis. Ann Intern Med. 2020;172(9):ITC65-ITC80. doi:10.7326/AITC202005050.
Disclosure
CM has received consulting fees from AbbVie, Alimentiv, Amgen, AVIR Pharma Inc, BioJAMP, Bristol Myers Squibb, Celltrion, Ferring, Fresenius Kabi, Janssen, McKesson, Mylan, Pendopharm, Pfizer, Prometheus Biosciences Inc., Roche, Sanofi, Takeda, Tillotts Pharma; speaker's fees from AbbVie, Amgen, AVIR Pharma Inc, Alimentiv, Bristol Myers Squibb, Ferring, Fresenius Kabi, Janssen, Organon, Pendopharm, Pfizer, Takeda; royalties from Springer Publishing; research support from Ferring, Pfizer.
TP, JJN, KB, and STT are employees and stockholders of Sanofi.
AR, AK and RBT are employees and stockholders of Regeneron Pharmaceuticals, Inc.
RP is a full-time employee of RTI Health Solutions, which received research funding from Sanofi to perform this study. RTI Health Solutions is a unit of Research Triangle Institute, an independent, non-profit, research organization that does work for government.
