High doses of the corticosteroid fluticasone propionate may safely and effectively induce remission of eosinophilic esophagitis (EoE) in many patients, a new study in the journal Gastroenterology reports. The research was funded by the National Institute of Allergy and Infectious Diseases (NIAID).
Marc Rothenberg, MD, PhD, from the Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, and colleagues administered oral doses of 1,760mcg of fluticasone propionate to 28 EoE patients over the course of three months while 14 participants received placebo. After three months, 65% of fluticasone propionate patients were in complete remission based on near absence of eosinophils in their esophageal tissues vs. none of the placebo patients. The patients in remission were then assigned to 880mcg of daily fluticasone propionate for another three months; 93% of them remained in complete or partial remission. Those who did not respond to fluticasone propionate during the first three months were then given 1760mcg for three additional months but were largely unresponsive to the treatment, which suggests that about 25% of EoE patients do not respond to steroid therapy.
The researchers also discovered that the gene expression signatures of patients in remission changed significantly by becoming similar to (although not identical) to healthy patients. Patients who did not respond to fluticasone propionate had only small gene expression signature changes, which could indicate a resistance to steroid drugs. Fifteen genes were identified that could be beneficial in determining if patients will respond to steroid treatment but additional research is needed for confirmation.
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