Hossein Haghbin, MD1, Manesh Kumar Gangwani, MD2, Amir Humza Sohail, MD3, Dushyant Singh. Dahiya, MD4, Wade M.. Lee-Smith, MLS5, Faisal Kamal, MD6, Muhammad Aziz, MD5 1Ascension Providence Hospital, Southfield, MI; 2University of Toledo Medical Center, Toledo, OH; 3NYU Langone Medical Center, New York, NY; 4University of Kansas School of Medicine, Kansas City, KS; 5University of Toledo, Toledo, OH; 6Thomas Jefferson Health, Philadephia, PA
Introduction: Multiple pharmacological interventions have been studied for managing eosinophilic esophagitis (EoE). We performed a comprehensive systematic review and network meta-analysis of all available randomized controlled trials (RCT) to assess the efficacy and safety of these interventions in EoE in adults and children.
Methods: We performed a comprehensive review of literature through May 10th, 2023 of the following databases: Embase, PubMed, MEDLINE OVID, Cochrane Central, Web of Science, and Korean Journal Index. We only included RCTs comparing one or more interventions to placebo or each other. A frequentist approach network meta-analysis was conducted using random effects model. Risk difference (RD) with 95% confidence interval (CI) were calculated for proportional outcomes. Two primary outcomes based on histology were assessed: (1) Based on study definition, and (2) Using the cut-off of ≤6 Eosinophils / high-power field (hpf).
Results: Our search yielded a total of 20 RCTs with 19 discrete interventions and 1430 patients randomized. Compared to placebo, the following interventions improved histology (based on study definitions): Dupilumab weekly (RD: 0.56, CI 0.38-0.74), Dupilumab q2weekly (RD: 0.56, CI: 0.28-0.83), Esomeprazole (RD: 0.67, CI: 0.33-1.00), Oral viscous budesonide (OVB) medium dose (RD: 0.54, CI: 0.33-0.75), OVB high dose (RD: 0.68, CI: 0.51–0.86), Orodispersible budesonide (OD) low (RD: 0.88, CI: 0.69–1.08), OD high (RD: 0.82, CI: 0.54–1.09), prednisone (RD: 0.55, CI: 0.16-0.95), Reslizumab 3mg/kg (RD: 0.33, CI: 0.01-0.65), and swallowed fluticasone (RD: 0.53, CI: 0.32-0.73).
Discussion: We demonstrated the efficacy of multiple medications for EoE through network meta-analysis. Our study provides guidance to clinicians to choose appropriate pharmacotherapy for their patient population.
Figure: Forest plot of histologic response of pharmacologic modalities compared to placebo.
Disclosures:
Hossein Haghbin indicated no relevant financial relationships.
Manesh Kumar Gangwani indicated no relevant financial relationships.
Amir Humza Sohail indicated no relevant financial relationships.
Dushyant Dahiya indicated no relevant financial relationships.
Wade Lee-Smith indicated no relevant financial relationships.
Faisal Kamal indicated no relevant financial relationships.
Muhammad Aziz indicated no relevant financial relationships.
Hossein Haghbin, MD1, Manesh Kumar Gangwani, MD2, Amir Humza Sohail, MD3, Dushyant Singh. Dahiya, MD4, Wade M.. Lee-Smith, MLS5, Faisal Kamal, MD6, Muhammad Aziz, MD5. P1852 - Comparative Efficacy of Pharmacotherapy in Eosinophilic Esophagitis: A Network Meta-Analysis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
