New research suggests that your body mass index (BMI) can influence your response to: topical corticosteroids (tCS) therapy eosinophilic esophagitis (EoE).
In a retrospective study, researchers observed that the higher the patient’s BMI level, the lower the individual’s response to tCS therapy from a symptomatic, endoscopic, and histological perspective.
Because there are few clinical predictors of response to topical steroids, clinicians may want to consider BMI in treatment algorithms when discussing treatment options with patients with EoE, researchers wrote in an article. . publish online of Clinical Gastroenterology and Hepatology.
For EoE, current guidelines recommend the use of proton pump inhibitor (PPI) therapy, topical steroids, and dietary restrictions.In addition, biological Dupilumab (Dupixent) is recently approved EoE in the United States.
Determining which therapy EoE patients respond to best remains a challenge, obesityThe role of in treatment response is unknown.
To investigate the effect of patient weight on tCS therapy, Evan Dellon, MD, MPH, of the University of North Carolina School of Medicine, Chapel Hill, and colleagues studied cases involving 296 adults and adolescents aged 14 years and older. Did. EoE steroids.
Although baseline characteristics were similar, heartburn was more common in 68 obese than nonobese patients (59% vs. 37%; P. = .001), and the proportion of endoscopically detected hiatal hernias was higher in obese patients (22% vs. 11%; P. = .02).
Obese patients had higher peak eosinophil counts compared to nonobese patients after tCS treatment (36.1 vs 21.5; P. = .003).
Histological response was significantly higher in nonobese compared with obese patients, with <15 eosinophils per high power field (eos/hpf: 61% vs 47%; P. = .049) and ≤ 6 eos/hpf (54% vs 38%; P. = .02).
In EoE lean patients, the overall endoscopic response to tCS was significantly greater than in obese patients (76% vs. 59%; P. = .006).
Furthermore, among nonobese patients, the post-treatment EoE-endoscopic reference score (2.4 vs. 3.2; P. = .01), and the endoscopic severity score was significantly lower (2.0 vs 2.4; P. = .05).
Overall symptomatic responses to tCS were seen in 84% of nonobese patients compared to only 67% of obese patients (P. = .03).
In multivariate analysis, increased BMI was associated with age, heartburn, dilation, and Hiatal hernia.
This relationship persisted whether or not BMI was assessed as a continuous variable (adjusted odds ratio). [aOR]0.93 for each unit increase in BMI), as lean versus obese (aOR 0.38), or overweight versus normal weight (aOR 0.46) or obese versus normal weight (aOR 0.26).
Different treatment algorithms?
Results were broadly similar when patients were stratified by PPI response status and continued PPI use.
The researchers noted that only five patients in their cohort responded to PPI therapy. All were non-obese. A patient with a high BMI initially may benefit from dual PPI/tCS treatment, but this strategy requires prospective evaluation, they note.
As to the mechanisms behind the apparent negative effects of obesity on tCS therapy, the researchers state that the mild systemic inflammatory state of obesity may reduce the effectiveness of tCS therapy, but the exact mechanism remains unclear. It adds that research is needed to identify
The study “suggests that clinicians can now add another epidemiological risk factor for potential poor response to EoE, particularly steroid treatment,” said Philip Katz, M.D., M.D. Professor, Gastroenterology and Hepatology, Weill Cornell Medicine, New York City, said Medscape Medical News when asked for comment.
But “from a retrospective study like this, it’s hard, if not impossible, to tell why higher BMI is a risk factor for poorer response,” said Katz, who was not involved in the study. said.
“The main potential clinical message here is that people who are overweight with EoE will probably need to look differently and may need different treatment algorithms or approaches than those of ideal weight.” It means that there is sexuality.
I have also commented on Medscape Medical NewsShreya Chablaney, MD, gastroenterologist at NYU Langone Health’s Center for Esophageal Health and clinical instructor at the NYU Grossman School of Medicine, says predictors of patient response to different treatment options for EoE are poorly understood. He pointed out the need for more robust data. Guide the selection of appropriate patients when considering them.
“This is a relatively small, single-center, retrospective study that found that higher BMI was independently associated with reduced histologic, symptomatic, and endoscopic responses to topical steroids. It shows an interesting finding: a hiatal hernia,” she said.
“While these findings may not yet have an impact on current management, there is a need to explore whether dose adjustments, topical steroid types, or alternative therapies should all be considered in obese patients. It highlights the need for more prospective research,” Chablaney said.
Support for this study was provided by the National Institutes of Health. Dellon, Abbott, AbbVie, Adare/Ellodi, Aimmune, Akesobio, ALK, Allakos, Amgen, Arena, Aslan, AstraZeneca, Avir, Biorasi, Calypso, Celgene/Receptos/BMS, Celldex, Eli Lilly, EsoCap, Eurpaxia, Ferring, GSK, Gossamer Bio, Invea, Landos, LucidDx, Morphic, Nutricia, Parexel/Calyx, Phathom, Regeneron, Revolo, Roberts/Alimentiv, Salix, Sanofi, Shire/Takeda, and Target RWE. Katz is a consultant at Phathom Pharmaceuticals and Sebella Pharmaceuticals and a member of AstraZeneca’s Advisory Board. Chablaney has not reported any related financial relationships.
Clin gastro hepatol. Published online on November 18, 2022. Overview
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