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Oesophagus
Original research
Comparison of drugs for active eosinophilic oesophagitis: systematic review and network meta-analysis
  1. Pierfrancesco Visaggi1,
  2. Brigida Barberio2,
  3. Giulio Del Corso3,
  4. Nicola de Bortoli1,
  5. Christopher J Black4,
  6. Alexander C Ford5,
  7. Edoardo Savarino6
  1. 1 Department of Translational Research and New Technologies in Medicine and Surgery, Faculty of Medicine and Surgery, University of Pisa, Pisa, Italy
  2. 2 Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
  3. 3 Institute of Information Science and Technologies 'A. Faedo', National Research Council of Italy (CNR), Pisa, Italy
  4. 4 Leeds Teaching Hospitals, NHS Trust, Leeds, UK
  5. 5 Leeds Gastroenterology Institute, St James's University Hospital, Leeds, UK
  6. 6 Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
  1. Correspondence to Professor Edoardo Savarino, Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova 35122, Italy; esavarino{at}libero.it

Abstract

Background There is currently no recommendation regarding preferred drugs for active eosinophilic oesophagitis (EoE) because their relative efficacy is unclear. We conducted an up-to-date network meta-analysis to compare proton pump inhibitors, off-label and EoE-specific topical steroids, and biologics in EoE.

Methods We searched MEDLINE, Embase, Embase Classic and the Cochrane Central Register of Controlled Trials from inception to June 2023. We included randomised controlled trials (RCTs) comparing efficacy of all drugs versus each other, or placebo, in adults and adolescents with active EoE. Results were reported as pooled relative risks with 95% CIs to summarise effect of each comparison tested, with drugs ranked according to P score

Results Seventeen RCTs were eligible for systematic review. Of these, 15 studies containing 1813 subjects with EoE reported extractable data for the network meta-analysis. For histological remission defined as ≤6 eosinophils/high-power field (HPF), lirentelimab 1 mg/kg monthly ranked first. For histological remission defined as ≤15 eosinophils/HPF, budesonide orally disintegrating tablet (BOT) 1 mg two times per day ranked first. For failure to achieve symptom improvement, BOT 1 mg two times per day and budesonide oral suspension (BOS) 2 mg two times per day were significantly more efficacious than placebo. For failure to achieve endoscopic improvement based on the EoE Endoscopic Reference Score, BOT 1 mg two times per day and BOS 1 mg two times per day or 2 mg two times per day were significantly more efficacious than placebo.

Conclusions Although this network meta-analysis supports the efficacy of most available drugs over placebo for EoE treatment, significant heterogeneity in eligibility criteria and outcome measures among available trials hampers the establishment of a solid therapeutic hierarchy.

  • META-ANALYSIS
  • OESOPHAGEAL DISEASE
  • OESOPHAGEAL DISORDERS

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/gutjnl-2023-329873

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • PV and BB are joint first authors.

    • Twitter @Pierfra_Visaggi, @bribarberio, @DrCJBlack

    • Contributors PV, BB, ACF and ES conceived and drafted the study. PV, BB, GDC, CB and ACF collected, analysed and interpreted all data. PV, BB, ACF and ES drafted the manuscript. PV, BB, GDC, NdB, CB, ACF and ES commented on drafts of the paper. All authors approved the final draft of the manuscript. PV and BB are joint first authors. ACF and ES are joint last authors. ES is guarantor of the article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests NdB served as speaker for Reckitt Benckiser, Malesci, Sofar, Alfa-Sigma, Dr Falk and Cadigroup. ES served as speaker for Abbvie, Agave, AGPharma, Alfasigma, Aurora Pharma, CaDiGroup, Celltrion, Dr Falk, EG Stada Group, Fenix Pharma, Fresenius Kabi, Galapagos, Janssen, JB Pharmaceuticals, Innovamedica/Adacyte, Malesci, Mayoly Biohealth, Omega Pharma, Pfizer, Reckitt Benckiser, Sandoz, SILA, Sofar, Takeda, Tillots and Unifarco; served as consultant for Abbvie, Agave, Alfasigma, Biogen, Bristol-Myers Squibb, Celltrion, Diadema Farmaceutici, Dr. Falk, Fenix Pharma, Fresenius Kabi, Janssen, JB Pharmaceuticals, Merck & Co, Reckitt Benckiser, Regeneron, Sanofi, SILA, Sofar, Synformulas GmbH, Takeda and Unifarco; received research support from Pfizer, Reckitt Benckiser, SILA, Sofar, Unifarco and Zeta Farmaceutici.

      PV, BB, GDC, CB and ACF have no competing interests.

    • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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