Efficacy of Biological and Steroid Therapies in Adolescent and Adult Patients With Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis With Meta-Regression.
Mohammad Al Hayek, Alfredo J Lucendo, Edoardo Vincenzo Savarino et al.
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In 30 seconds
This systematic review and network meta-analysis compared pharmacological treatments for eosinophilic esophagitis in participants aged 12 years or older, using 13 randomized controlled trials. Dupilumab ranked highest for dysphagia improvement at 12 and 24 weeks (SUCRA 92% and 97%), while budesonide orodispersible tablets 1 mg ranked highest at 48 weeks (96%). Most evaluated agents improved histologic remission, but symptomatic benefit was reported for fewer therapies, indicating that tissue and symptom responses may differ.
Key findings
- Dupilumab ranked highest for dysphagia improvement at 12 and 24 weeks, with SUCRA values of 92% and 97%.
- Budesonide orodispersible tablets 1 mg ranked highest for dysphagia improvement at 48 weeks (SUCRA 96%).
- All agents except etrasimod showed moderate-certainty benefit for histologic remission versus placebo across time points.
- Histologic remission benefits did not consistently correspond to symptomatic improvement; only dupilumab, cendakimab, BOS, and BOT were associated with dysphagia improvement.
Why it matters
The findings underscore that histologic response and dysphagia improvement are not interchangeable measures of treatment effect in EoE. Comparative rankings may help frame treatment discussions, but they do not establish a definitive hierarchy: most corticosteroid trials were short-term, and direct comparisons with biologics were lacking. The review also highlights the need to interpret symptom, endoscopic, and histologic outcomes together.
What to keep in mind
Most corticosteroid trials were short-term and lacked direct comparisons with biologics; the authors call for robust head-to-head trials and longer-term outcome data.