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

BACKGROUND AND AIMS: Limited real-world nontertiary 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 fi rst endoscopy date during the 180 days before and the 365 days after the fi rst EoE diagnosis). Clinical fi ndings, all-cause healthcare resource utilization, 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 fi eld (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 healthcare resource utilization. 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 fi rst 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.