From the Guidelines
The treatment for eosinophilic oesophagitis (EoE) primarily involves topical steroids, with budesonide being the preferred choice due to its high efficacy in inducing histological and clinical remission, as shown in a recent study 1. The dosage of budesonide varies depending on the patient's age and height, with an induction dosage of 1 mg/day for children under 150 cm and 2 mg/day for children over 150 cm, given as a single dose or divided into two doses per day. In adults, the use of orodispersible budesonide is supported due to its regulatory approval and high efficacy, with a dosage of 1 mg twice a day. Improvement in eosinophil count typically begins within 6 weeks of starting treatment, with clinicopathological remission achieved in 57.6% of patients at week 6 and 84% at week 12, as demonstrated in a landmark study 1. Key points to consider in the treatment of EoE include:
- Topical steroids are the mainstay of treatment, with budesonide being the preferred choice
- Dosage varies depending on age and height
- Improvement in eosinophil count typically begins within 6 weeks of starting treatment
- Clinicopathological remission can be achieved in a significant proportion of patients within 12 weeks of treatment. The treatment should be tailored to the individual patient's needs, with regular monitoring of eosinophil counts and clinical symptoms to adjust the treatment plan as necessary. As noted in a technical review on the management of EoE, there is moderate certainty in the evidence that topical glucocorticosteroids effectively reduce esophageal eosinophil counts to <15/hpf over a short-term treatment period of 4–12 weeks 1. However, the most recent and highest quality study supports the use of budesonide as the first-line treatment for EoE, due to its high efficacy and safety profile 1.
From the FDA Drug Label
2.14 Dosage Modifications for Hematologic Adverse Reactions Dose reduction or treatment interruptions for severe neutropenia and thrombocytopenia are recommended as indicated in Table 1 Table 1: Dose Adjustments for Neutropenia and Thrombocytopenia ASM associated with eosinophilia (starting dose 100 mg) ANC less than 1 x 10^9/L and/or platelets less than 50 x 10^9/L Stop Imkeldi until ANC greater than or equal to 1.5 x 10^9/L and platelets greater than or equal to 75 x 10^9/L Resume treatment with Imkeldi at previous dose (i.e., dose before severe adverse reaction)
The treatment regimen for dress (likely referring to a condition associated with eosinophilia) involves stopping Imkeldi until the ANC (Absolute Neutrophil Count) is greater than or equal to 1.5 x 10^9/L and platelets are greater than or equal to 75 x 10^9/L. Then, treatment with Imkeldi can be resumed at the previous dose. Key points:
- Stop Imkeldi if ANC is less than 1 x 10^9/L and/or platelets are less than 50 x 10^9/L.
- Resume treatment when ANC is greater than or equal to 1.5 x 10^9/L and platelets are greater than or equal to 75 x 10^9/L. Improvement in eosinophil count is expected once the treatment is resumed, but the exact timeline is not specified in the provided drug label 2.
From the Research
Treatment Regime for Eosinophilia
The treatment regime for eosinophilia typically involves a combination of medications to control the eosinophil count and prevent organ damage. The choice of treatment depends on the underlying cause of eosinophilia and the severity of the condition.
- Corticosteroids, such as prednisone, are often used as first-line therapy for patients with lymphocyte-variant hypereosinophilia and idiopathic hypereosinophilic syndrome (HES) 3, 4.
- Hydroxyurea and interferon-alpha have also demonstrated efficacy as initial treatment and in steroid-refractory cases of HES 3, 4.
- Imatinib is a highly effective treatment for patients with rearranged PDGFRA or PDGFRB 3, 4, 5.
- Antibodies against interleukin-5 (IL-5), such as mepolizumab, have shown promise in the treatment of HES 5.
Monitoring Eosinophil Count
The eosinophil count should be monitored regularly to assess the effectiveness of treatment.
- For patients with milder forms of eosinophilia (<1.5 × 10^9/L) without symptoms or signs of organ involvement, a watch and wait approach with close follow-up may be undertaken 3, 4.
- For patients with more severe eosinophilia or symptoms of organ involvement, regular monitoring of the eosinophil count is crucial to adjust treatment as needed 3, 4.
- The goal of therapy is to mitigate eosinophil-mediated organ damage, and treatment should be adjusted accordingly 3, 4.
Expected Time to See Improvement
The expected time to see improvement in eosinophil count varies depending on the treatment and the individual patient.
- Corticosteroids can lead to a rapid decrease in eosinophil count, often within days to weeks 6.
- Hydroxyurea and interferon-alpha may take longer to show efficacy, typically several weeks to months 3, 4.
- Imatinib can lead to a rapid and sustained decrease in eosinophil count, often within weeks to months 5.