The clinical impact of conventional therapies for adults and adolescents suffering from eosinophilic esophagitis, a type 2 inflammatory chronic disease, and their economic consequences in Italy: Systematic literature review and meta-analysis
Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder marked by eosinophilic infiltration of the esophageal mucosa. Despite advances in understanding and management, optimal therapeutic strategies remain unclear, with conflicting guidelines. Objective: We sought to evaluate e...
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Elsevier
2025-02-01
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| Series: | Journal of Allergy and Clinical Immunology: Global |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772829324001796 |
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| author | Giorgio Walter Canonica, MD Gherardo Mazziotti, MD, PhD Alessandro Repici, MD Massimiliano Povero, PhD Luca Castello, MSc Lorenzo Pradelli, MD Miryana Dobreva, MSc Francesca Fanelli, MSc Jean Pierre Saab, MD Edoardo Vincenzo Savarino, MD, PhD |
| author_facet | Giorgio Walter Canonica, MD Gherardo Mazziotti, MD, PhD Alessandro Repici, MD Massimiliano Povero, PhD Luca Castello, MSc Lorenzo Pradelli, MD Miryana Dobreva, MSc Francesca Fanelli, MSc Jean Pierre Saab, MD Edoardo Vincenzo Savarino, MD, PhD |
| author_sort | Giorgio Walter Canonica, MD |
| collection | DOAJ |
| description | Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder marked by eosinophilic infiltration of the esophageal mucosa. Despite advances in understanding and management, optimal therapeutic strategies remain unclear, with conflicting guidelines. Objective: We sought to evaluate effectiveness and safety of topical corticosteroids (TCSs) and proton pump inhibitors (PPIs) in managing EoE and their economic implications in Italy. Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched up to December 2023 and 78 publications were included, covering treatment outcomes and adverse events. Meta-analyses were performed to evaluate treatment efficacy and safety across various patient populations and study designs. Results: TCSs showed superior efficacy over PPIs in achieving histologic, endoscopic, and partial clinical responses. Older patients responded better to both treatments. Treatment outcomes varied by sex and presence of atopic conditions. TCSs discontinuation increased the risk of clinical relapse (0.70 cases per person-year), whereas continuous use was linked to a rise in nonserious adverse events (dilation, infections, upper respiratory tract infections, and skin disorders). Economic analysis indicated cost variations based on treatment regimens and follow-up protocols, with dilation and relapse being significant cost drivers in Italy. Conclusions: This review provides insights into efficacy, safety, and economic impact of TCSs and PPIs in managing EoE. TCSs were more effective in achieving histologic and endoscopic responses, whereas PPIs were effective in reducing symptoms. Standardized treatment guidelines are needed because of varied treatment efficacy across studies. Future research and new therapies may enhance outcomes and reduce health care costs, improving patient quality of life. |
| format | Article |
| id | doaj-art-f6e58eba8bbc4b41bca8e05cda74852b |
| institution | Kabale University |
| issn | 2772-8293 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Allergy and Clinical Immunology: Global |
| spelling | doaj-art-f6e58eba8bbc4b41bca8e05cda74852b2025-01-11T06:42:20ZengElsevierJournal of Allergy and Clinical Immunology: Global2772-82932025-02-0141100383The clinical impact of conventional therapies for adults and adolescents suffering from eosinophilic esophagitis, a type 2 inflammatory chronic disease, and their economic consequences in Italy: Systematic literature review and meta-analysisGiorgio Walter Canonica, MD0Gherardo Mazziotti, MD, PhD1Alessandro Repici, MD2Massimiliano Povero, PhD3Luca Castello, MSc4Lorenzo Pradelli, MD5Miryana Dobreva, MSc6Francesca Fanelli, MSc7Jean Pierre Saab, MD8Edoardo Vincenzo Savarino, MD, PhD9Department of Biomedical Sciences, Humanitas University of Milan, Pieve Emanuele, Milan, Italy; Personalized Medicine Asthma & Allergy Clinic Humanitas Research Hospital—IRCCS, Rozzano, Milan, ItalyDepartment of Biomedical Sciences, Humanitas University of Milan, Pieve Emanuele, Milan, Italy; Endocrinology, Diabetology and Medical Andrology Unit, Metabolic Bone Diseases and Osteoporosis Section, IRCCS Humanitas Research Hospital, Milan, ItalyDepartment of Gastroenterology Humanitas University & Humanitas Research Hospital, Rozzano, Milan, ItalyAdRes SrL, Turin, ItalyAdRes SrL, Turin, ItalyAdRes SrL, Turin, ItalySanofi Italia, Milan, ItalySanofi Italia, Milan, ItalySanofi Italia, Milan, ItalyDivision of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Corresponding author: Edoardo Vincenzo Savarino, MD, PhD, Via Giustiniani, 2, Padua, Italy.Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder marked by eosinophilic infiltration of the esophageal mucosa. Despite advances in understanding and management, optimal therapeutic strategies remain unclear, with conflicting guidelines. Objective: We sought to evaluate effectiveness and safety of topical corticosteroids (TCSs) and proton pump inhibitors (PPIs) in managing EoE and their economic implications in Italy. Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched up to December 2023 and 78 publications were included, covering treatment outcomes and adverse events. Meta-analyses were performed to evaluate treatment efficacy and safety across various patient populations and study designs. Results: TCSs showed superior efficacy over PPIs in achieving histologic, endoscopic, and partial clinical responses. Older patients responded better to both treatments. Treatment outcomes varied by sex and presence of atopic conditions. TCSs discontinuation increased the risk of clinical relapse (0.70 cases per person-year), whereas continuous use was linked to a rise in nonserious adverse events (dilation, infections, upper respiratory tract infections, and skin disorders). Economic analysis indicated cost variations based on treatment regimens and follow-up protocols, with dilation and relapse being significant cost drivers in Italy. Conclusions: This review provides insights into efficacy, safety, and economic impact of TCSs and PPIs in managing EoE. TCSs were more effective in achieving histologic and endoscopic responses, whereas PPIs were effective in reducing symptoms. Standardized treatment guidelines are needed because of varied treatment efficacy across studies. Future research and new therapies may enhance outcomes and reduce health care costs, improving patient quality of life.http://www.sciencedirect.com/science/article/pii/S2772829324001796Eosinophilic esophagitistreatment responseeconomic burdensystematic reviewproton pump inhibitorstopical corticosteroids |
| spellingShingle | Giorgio Walter Canonica, MD Gherardo Mazziotti, MD, PhD Alessandro Repici, MD Massimiliano Povero, PhD Luca Castello, MSc Lorenzo Pradelli, MD Miryana Dobreva, MSc Francesca Fanelli, MSc Jean Pierre Saab, MD Edoardo Vincenzo Savarino, MD, PhD The clinical impact of conventional therapies for adults and adolescents suffering from eosinophilic esophagitis, a type 2 inflammatory chronic disease, and their economic consequences in Italy: Systematic literature review and meta-analysis Journal of Allergy and Clinical Immunology: Global Eosinophilic esophagitis treatment response economic burden systematic review proton pump inhibitors topical corticosteroids |
| title | The clinical impact of conventional therapies for adults and adolescents suffering from eosinophilic esophagitis, a type 2 inflammatory chronic disease, and their economic consequences in Italy: Systematic literature review and meta-analysis |
| title_full | The clinical impact of conventional therapies for adults and adolescents suffering from eosinophilic esophagitis, a type 2 inflammatory chronic disease, and their economic consequences in Italy: Systematic literature review and meta-analysis |
| title_fullStr | The clinical impact of conventional therapies for adults and adolescents suffering from eosinophilic esophagitis, a type 2 inflammatory chronic disease, and their economic consequences in Italy: Systematic literature review and meta-analysis |
| title_full_unstemmed | The clinical impact of conventional therapies for adults and adolescents suffering from eosinophilic esophagitis, a type 2 inflammatory chronic disease, and their economic consequences in Italy: Systematic literature review and meta-analysis |
| title_short | The clinical impact of conventional therapies for adults and adolescents suffering from eosinophilic esophagitis, a type 2 inflammatory chronic disease, and their economic consequences in Italy: Systematic literature review and meta-analysis |
| title_sort | clinical impact of conventional therapies for adults and adolescents suffering from eosinophilic esophagitis a type 2 inflammatory chronic disease and their economic consequences in italy systematic literature review and meta analysis |
| topic | Eosinophilic esophagitis treatment response economic burden systematic review proton pump inhibitors topical corticosteroids |
| url | http://www.sciencedirect.com/science/article/pii/S2772829324001796 |
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