Determination of a treatment response threshold for the Eosinophilic Esophagitis Endoscopic Reference Score.
Endoscopy
; 54(7): 635-643, 2022 07.
Article
em En
| MEDLINE
| ID: mdl-34674209
ABSTRACT
BACKGROUND:
Endoscopic features of eosinophilic esophagitis (EoE) are measured using the validated EoE Endoscopic Reference Score (EREFS); however, a threshold for treatment response has not been defined. We aimed to determine a cut-point for endoscopic response as measured by EREFS.METHODS:
We performed a secondary analysis of a randomized clinical trial comparing budesonide slurry with swallowed fluticasone multidose inhaler for initial treatment of EoE. In the parent trial, EREFS was determined before and after treatment (score range 0-9), as were histologic findings and dysphagia symptoms. We performed tabular, flexible trend, and dependent mixture analyses of measures of treatment response to select the best clinical EREFS threshold.RESULTS:
In the 111 included patients (mean age 39 years; 67â% male; 96â% white), an EREFS threshold of ≤â2 was 80â% sensitive (95â% confidence interval [CI] 69â% to 88â%) and 83â% specific (95â%CI 67â% to 94â%) for histologic response (peak ofâ<â15 eosinophils per high-power field). Flexible trend analysis and dependent mixture modeling similarly suggested that a threshold of ≤â2 best captured the correlation of EREFS with histologic and symptomatic measures. Dependent mixture modeling found near-total membership in the response class at EREFS of 0 or 1 and >â75â% at EREFS of 2 or 3.CONCLUSIONS:
An EREFS of ≤â2 was the best clinical threshold for endoscopic response to topical steroid treatment, and was consistent with clinical and histologic response. Therefore, future studies can report a binary outcome of endoscopic response when EREFS is 2 or less.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Transtornos de Deglutição
/
Esofagite Eosinofílica
Tipo de estudo:
Clinical_trials
/
Prognostic_studies
Limite:
Adult
/
Female
/
Humans
/
Male
Idioma:
En
Revista:
Endoscopy
Ano de publicação:
2022
Tipo de documento:
Article
País de afiliação:
Estados Unidos