For eosinophilic esophagitis (EoE), apart from steroids , newer therapeutic interventions and relevant randomised controlled trials (RCTs) are available that have not been included in previous meta-analyses [2-6]. Network meta-analysis (NWM) is an evidence synthesis tool for comparing RCTs with multiple treatments [7-9]. The aim was to evaluate the comparative efficacy of various drug therapies in EoE and to re-examine the current evidence concerning EoE treatment in adults and children.
FIGURE. Rankograms for the eosinophilic esophagitis intervention network showing the cumulative rank order for each of the 15 therapeutic interventions. BOT, budesonide orodispersible tablet; NS, nebulised steroid; OBS, oral budesonide suspension.
A NWM was performed to combine direct and indirect data to investigate the efficiency of drug therapies, which were evaluated in relevant RCTs for EoE.
Seventeen eligible studies (14 two-arm and 3 multiple-arm) were introduced to the meta-analysis [10-26]. A total of 1,011 patients were included, in whom 15 therapeutic interventions were used, namely: (1) budesonide oral suspension, (2) budesonide 1 mg orodispersible tablet twice daily, (3) budesonide 2 mg orodispersible tablet twice daily, (4) esomeprazole, (5) fluticasone, (6) nebulised steroid, (7) placebo, (8) prednisone, (9) anti-IL-5-mab (mepolizumab), (10) anti-IL-5-mab [reslizumab 1 mg/kg], (11) anti-IL-5-mab [reslizumab 2 mg/kg], (12) anti-IL-5-mab [reslizumab 3 mg/kg], (13) anti-IL-13-mab (QAX 576), (14) anti-IL-13-mab [RCP 4046 (180)], and (15) anti-IL-13-mab [RCP 4046 (360)]. Budesonide 1 mg orodispersible tablet twice daily showed the highest efficacy (surface under the cumulative ranking [SUCRA] 0.91), whereas placebo was the least effective (see Figure).
This NWM suggests that overall among various therapeutic interventions tested in RCTs, budesonide 1 mg orodispersible tablet twice daily is the best therapeutic intervention for EoE. Subgroup NWM of RCTs according to patient’s age demonstrated that budesonide 1 mg orodispersible tablet remained the optimal therapeutic approach in adults, whereas the respective optimal treatment in paediatric patients was fluticasone, due systemic bioavailability.
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