Treatment Patterns and Persistent Disease Activity in Patients With Eosinophilic Esophagitis: A Retrospective Cohort Study

BACKGROUND AND AIMS Limited real-world non-tertiary care evidence on the patient therapeutic journey and disease burden of eosinophilic esophagitis (EoE) exists. The aim was to collect real-world data on the EoE patient journey across different age groups. METHODS This retrospective, real-world, cohort study used electronic medical records and claims data provided by a rural integrated US healthcare system. Eligibility criteria included: ≥2 diagnoses of EoE (2009–2018); ≥1 endoscopy; and ≥12 months of data before and after the index date (the first endoscopy date during the 180 days before and the 365 days after the first EoE diagnosis). Clinical findings, all-cause healthcare resource utilization (HCRU), specialists consulted, therapies, and markers of disease progression were analyzed. RESULTS Overall, 613 patients were enrolled: 0–11 (children, n=182); 12–17 (adolescents, n=146); 18–54 (adults, n=244); and ≥55 years old (older adults, n=41). Post index, the prevalence of signs and symptoms increased. At baseline, most endoscopies were abnormal (80.5%) and most peak eosinophil counts were >15 eosinophils/high-power field (87.9%); post index, all age groups had endoscopic and histologic improvements. However, 3 years post index, abnormal endoscopic appearance (62.3%) and histologic activity (51.2%) were observed. Patients of all ages exhibited considerable all-cause HCRU. During follow-up, 86.3% of patients consulted a specialist. Before and after index, proton pump inhibitors and corticosteroids were the most commonly used pharmacological therapies; 44.0% of patients discontinued their first treatment post index. Disease progression occurred in 13.9% of patients post index. CONCLUSION In this setting, patients with EoE irrespective of age face difficult therapeutic journeys with substantial disease burden.