Daily or twice daily treatment with topical steroids results in similar responses in eosinophilic esophagitis.

Background and aims: Few data compare topical corticosteroid (tCS) dosing regimens and outcomes. We aimed to compare treatment outcomes in eosinophilic esophagitis (EoE) patients by once or twice daily dosing regimens.

Methods: We conducted a retrospective cohort study utilizing the UNC EoE Clinicopathologic Database of newly diagnosed EoE patients treated with a tCS who had a follow-up endoscopy with biopsy. Baseline data and outcomes were extracted. Bivariate and multivariate analyses compared patients at baseline and following initial tCS given as a once or twice daily dose.

Results: 522 patients met inclusion criteria, 122 patients on once daily dosing (72% male; 91% white) and 400 patients on twice daily dosing (66% male; 89% white). Patients on twice daily dosing were older (28.8 ± 18.2 vs. 24.3 ± 18.0; p = 0.01) and reported more heartburn (40% vs. 25%; p = 0.004). On bivariate analysis, global symptomatic response (78% vs. 76%; p = 0.82), post-treatment eosinophil count (20.8 ± 27.2 vs. 25.6 ± 39.4; p = 0.21), post-treatment EREFS (2.2 ± 1.8 vs. 2.2 ± 2.0; p = 0.92), and histologic response (<15 eos/hpf; 56% vs 58%; p = 0.66) did not differ. Candida was less frequent with daily dosing (2% vs. 8%; p = 0.04). In multivariate analysis, the odds of histologic response did not differ by dose groups (aOR: 1.03; 95% CI: 0.67 - 1.60).

Conclusions: EoE outcomes did not differ by daily or twice daily dosing regimens. These results inform tCS dosing regimens and reassure that both are effective.