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Eosinophilic oesophagitis: the advantages of orodispersible budesonide (Jorveza°)

Orodispersible tablets of budesonide are being proposed for the treatment of eosinophilic oesophagitis, an immune-mediated disease. Budesonide is a corticosteroid already used in other forms and in other settings. The orodispersible form is better suited to oesophageal disease, with demonstrated efficacy against symptoms.

Eosinophilic oesophagitis, a chronic immune-mediated disease, can develop at any age, with a peak incidence at around age 30. It affects mainly men and arises most often in a background of allergic conditions such as food allergy, asthma, or atopic eczema. In adults, it presents especially with dysphagia (difficulty in swallowing), heartburn, chest discomfort and upper abdominal pain. It often disrupts eating and has important consequences for patients' everyday lives. In the long term, it carries a risk of oesophageal fibrosis.

Budesonide, a corticosteroid already authorised for certain chronic inflammatory diseases of the airways and gastrointestinal tract, is also available for eosinophilic oesophagitis in adults, in the form of tablets to be dissolved in the mouth (so-called orodispersible tablets) (Jorveza°). This treatment is aimed mainly at relieving symptoms and preventing the risk of oesophageal fibrosis.

In two trials with adults having eosinophilic oesophagitis, budesonide as orodispersible tablets relieved symptoms of dysphagia in about half of the patients compared to placebo, with the clinical response being maintained in about half of the responders, as long as they continued to take the drug.

Budesonide mainly carries a risk of local candidiasis. With prolonged treatment, a risk of systemic adverse effects is predictable, hence in this situation the 1 mg-per-day dose should be preferred. The special method of administration should be respected (dissolving the tablet in the mouth without chewing or swallowing it, waiting at least 30 minutes before eating or drinking).

©Prescrire 1 February 2022

Source: "Budesonide (Jorveza°) orodispersible tablets in eosinophilic oesophagitis" Prescrire International 2022; 31 (234): 39. Subscribers only.

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