Fluticasone improves histologic eosinophilia in esophagitis

To determine whether aerosolized fluticasone therapy improved symptomatic dysphagia and histologic eosinophilia, Jeffrey A. Alexander, M.D., of the Mayo Clinic College of Medicine in Rochester, Minn., and colleagues conducted a randomized, double-blind, placebo-controlled trial involving adults (mean age, 37.5 years) with a new diagnosis of EoE. For six weeks, patients either swallowed 880 µg of aerosolized fluticasone (21 participants) or used a placebo inhaler twice daily (15 participants).

The researchers found that 62 percent of fluticasone-treated patients showed a complete histologic response, defined as a >90 percent reduction in mean eosinophil count, compared with none in the placebo group, in intention-to-treat analysis. In per-protocol analysis, 68 versus 0 percent had a histologic response. Eighty-one versus 8 percent of fluticasone- versus placebo-treated patients exhibited reduced eosinophil-derived neurotoxin staining. Dysphagia was reduced in 57 and 33 percent of patients treated with fluticasone and placebo, respectively (P = 0.22), in intention-to-treat analysis, and in 63 and 47 percent, respectively (P = 0.49), in per-protocol analysis. Esophageal candidiasis developed in 26 percent of fluticasone-treated patients and no patients in the placebo group.

"In summary, this double-blind, placebo-controlled six-week trial of aerosolized fluticasone in the treatment of EoE found the treatment efficacious at decreasing esophageal eosinophilia and eosinophil activity," the authors write. "This histologic response, however, was not accompanied by a relief of symptomatic dysphagia."

One author disclosed financial ties to Meritage Pharmacia.

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Journal reference: Clinical Gastroenterology and Hepatology

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