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Background & Aims
We evaluated the effect of aerosolized fluticasone therapy on sy
mpto
matic dysphagia and histologic eosinophilia in adults with eosinophilic esophagitis (EoE).
Methods
We performed a double-blind, randomized, placebo-controlled trial of fluticasone in 42 adult patients with a new diagnosis of EoE (30 men; mean age, 37.5 y). Participants were assigned randomly to groups that swallowed 880 渭g of aerosolized fluticasone twice daily (n = 21), or took a placebo inhaler twice daily (n = 15) for 6 weeks. End points of the study were symptomatic and histologic response.
Results
A complete histologic response (>90%decrease in mean eosinophil count) was observed in 11 of 15 subjects who received 6 weeks of fluticasone (62%), compared with none of the 15 subjects who received placebo (m>Pm> < .001), based on intention-to-treat analysis; histologic responses were observed in 68%of subjects who received fluticasone (13 of 19) compared with none of those who received placebo (0 of 15) by per-protocol analysis (m>Pm> < .001). Intracellular staining for eosinophil-derived neurotoxin was reduced in 81%of subjects who received fluticasone (13 of 16) compared with 8%who received placebo (1 of 13) (m>Pm> < .001). Dysphagia was reduced in 57%of subjects who received fluticasone (12 of 21) compared with 33%who received placebo (7 of 21) (m>Pm> = .22) by intention-to-treat analysis; dysphagia was reduced in 63%of patients who received fluticasone (12 of 19) and 47%of those who received placebo (7 of 15) (m>Pm> = .49) based on per-protocol analysis. Esophageal candidiasis developed in 26%of subjects who received fluticasone (5 of 19), but in none of the subjects in the placebo group (m>Pm> = .05).
Conclusions
Aerosolized, swallowed fluticasone leads to a histologic but not a symptomatic response in adults with EoE.