Ciclesonide Impacts Clinicopathological Features of Eosinophilic Esophagitis

Mason Nistel; Nathalie Nguyen; Dan Atkins; Heather Miyazawa; Cassandra Burger; Glenn T Furuta; Calies Menard-Katcher

doi:10.1016/j.jaip.2021.06.058

Ciclesonide Impacts Clinicopathological Features of Eosinophilic Esophagitis

J Allergy Clin Immunol Pract. 2021 Nov;9(11):4069-4074. doi: 10.1016/j.jaip.2021.06.058. Epub 2021 Jul 19.

Authors

Mason Nistel¹, Nathalie Nguyen², Dan Atkins², Heather Miyazawa², Cassandra Burger², Glenn T Furuta², Calies Menard-Katcher²

Affiliations

¹ Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, Colo; Digestive Health Institute, Children's Hospital Colorado, Aurora, Colo; Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, Colo. Electronic address: mason.nistel@childrenscolorado.org.
² Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, Colo; Digestive Health Institute, Children's Hospital Colorado, Aurora, Colo; Mucosal Inflammation Program, University of Colorado School of Medicine, Aurora, Colo.

PMID: 34293498
DOI: 10.1016/j.jaip.2021.06.058

Abstract

Background: Eosinophilic esophagitis (EoE) is a chronic allergen-mediated disease of the esophagus. Pharmacologic treatment has largely relied on repurposing corticosteroids. Ciclesonide (CIC) is a corticosteroid for the treatment of asthma with biochemical properties that improve topical potency.

Objective: To determine whether CIC decreased clinicopathological features of EoE.

Methods: We performed a retrospective cohort study of patients with EoE treated with CIC at a pediatric hospital from 2010 to 2019. Data were extracted from the electronic health record. Patients who were prescribed CIC with pre- and post-CIC endoscopic and histological data available were included for analysis.

Results: A total of 281 patients were treated with CIC and 81 met criteria for inclusion. Use of CIC was associated with reduced symptoms including dysphagia (P < .001), abdominal pain (P < .001), vomiting (P = .01), heartburn (P = .02), and behavior changes (P = .02). Average composite endoscopic reference scores decreased from 2.54 to 1.37 (P < .001), with improvement in exudates, edema, and furrows (all P < .001). Peak eosinophil counts decreased from 48 to 23 eosinophils/hpf (P < .001). Forty-three patients (53%) achieved remission (<15 eosinophils/hpf). Esophageal Candida was reported in 1 patient. Fasting morning cortisol concentrations were low in 10 of 31 patients tested. Six of these 10 patients had abnormal adrenocorticotropic hormone stimulation testing, 5 of 6 diagnosed with adrenal insufficiency before transition to CIC and 3 of 6 with subsequent normalization of adrenal function on CIC therapy.

Conclusions: Patients with EoE treated with CIC experienced significant reductions in clinicopathological features of EoE. CIC can be considered an alternative therapy in patients with known adrenal insufficiency or at risk of developing adrenal insufficiency.

Keywords: Adolescent; Esophageal inflammation; Pediatric; Swallowed topical steroids.

MeSH terms

Child
Eosinophilic Esophagitis* / drug therapy
Eosinophils
Humans
Pregnenediones* / therapeutic use
Retrospective Studies

Substances

Pregnenediones
ciclesonide

Grants and funding

T32 DK067009/DK/NIDDK NIH HHS/United States