P1367 - Steroid Exposure in Patients With Eosinophilic Esophagitis (EoE) From the United States

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

SN

Sarah Naeger, PhD

Sanofi Genzyme
Rockville, MD, United States

Sarah Naeger, PhD¹, Urvi Mujumdar, PhD¹, Kiran Patel, MD¹, Arpita Nag, PhD, MBA, MS, BPharm¹, Eilish McCann, PhD², Benjamin Ortiz, MD³, Chao Chen, PhD³, Ledia Goga, PhD⁴
¹Sanofi Genzyme, Cambridge, MA; ²Regeneron Pharmaceuticals, Tarrytown, NY; ³Regeneron Pharmaceuticals, Inc., Tarrytown, NY; ⁴Sanofi, Cambridge, MA

Introduction: Certain corticosteroids are recommended for treatment of the chronic immune-mediated disease, eosinophilic esophagitis (EoE), alongside proton pump inhibitors and dietary modifications. This study aimed to describe a cohort of patients with EoE and their treatment with corticosteroids by age.

Methods: This was a retrospective analysis of the Clinformatics Data Mart (2007–2021;Optum). Eligible patients had ≥1 inpatient or ≥2 outpatient claims (≥30 to < 365 days apart) between 1/1/08-1/31/20 and associated with an ICD9 or ICD10 diagnosis for EoE. Patients had 1y continuous enrollment (up to 31-day allowable gap) before and after first index inpatient/outpatient event. EoE patients were stratified by age (years): 0-6; 7-12; 13-18; 19-55; ≥56. Demographics were extracted alongside comorbidities (in 1y preindex period) and treatment history with oral (OCS), inhaled (ICS), or topical corticosteroids (TCS) identified by National Drug Codes (in 1y pre- and postindex).

Results: In total 4368 patients with EoE were identified (0-6y, n=270; 7-12y, n=403; 13-18y, n=373; 19-55y, n=2729; ≥56y, n=593). Mean(±SD) age was 34.4±18.4y. Patients were more commonly male (64.5%), but this varied across cohort (57.2% [≥56y] to 76.3% [0-6y]) (Table). Common Type 2 inflammatory comorbidities in the 1y preindex period included allergic rhinitis (24.1%) and asthma (18.9%), and these were most often recorded in children (≤18y; Table). 862 patients (19.7%) were treated with OCS at any time during 1y preindex period, with highest use in the youngest cohort (27.4% [0-6y]). ICS were used by 16.6% patients during preindex period, and use was highest in those aged 0-6y (37.8%). TCS were used by fewer patients (10.3%), but most often in the youngest cohort (0-6y, 22.2%). The number of patients dispensed corticosteroids in the 1y postindex period varied across age cohorts (14.5%-24.1% for OCS, 22.4%-48.5% for ICS,6.2%-16.7% for TCS), but use was highest in patients 0-6y (Table).

Discussion: This analysis of 4368 patients with EoE allowed patient demographic and clinical characteristics to be described by age. These patients with EoE were mostly ≥19y. Concomitant inflammatory conditions and prescribed corticosteroids were reported more frequently in younger patients. Further study is needed to investigate the association between cumulative steroid use in EoE and/or other comorbid diagnoses. GI specialists should consider prior exposure when prescribing steroids for EoE, as cumulative burden increases with a lifelong disease.

	Total Population	Aged 0-6 years	Aged 7-12 years	Aged 13-18 years	Aged 19-55 years	Aged ≥56 years
	N=4368	n=270	n=403	n=373	n=2729	n=593
Age, mean ± SD, years	34.44±18.41	3.53±1.70	9.59±1.67	15.45±1.70	37.34±9.86	63.99±6.95
Male, n (%)	2818 (64.5%)	206 (76.3%)	290 (72.0%)	275 (73.7%)	1708 (62.6%)	339 (57.2%)
Race, n (%)
White	3420 (78.3%)	161 (59.6%)	298 (73.9%)	288 (77.2%)	2217 (81.2%)	456 (76.9%)
Asian	108 (2.5%)	15 (5.6%)	21 (5.2%)	11 (2.9%)	43 (1.6%)	18 (3.0%)
African American	219 (5.0%)	25 (9.3%)	21 (5.2%)	11 (2.9%)	129 (4.7%)	33 (5.6%)
Hispanic	244 (5.6%)	18 (6.7%)	26 (6.5%)	21 (5.6%)	148 (5.4%)	31 (5.2%)
Other/Unknown	377 (8.6%)	51 (18.9%)	37 (9.2%)	42 (11.3%)	192 (7.0%)	55 (9.3%)
*Low Income Status, n (%)**
Above 400% FPL	3549 (81.2%)	188 (69.6%)	314 (77.9%)	308 (82.6%)	2233 (81.8%)	506 (85.3%)
Below 400% FPL	8 (0.2%)	1 (0.4%)	3 (0.7%)	0 (0%)	4 (0.1%)	0 (0%)
Missing/Unknown	811 (18.6%)	81 (30.0%)	86 (21.3%)	65 (17.4%)	492 (18.0%)	87 (14.7%)
Type 2 inflammatory Comorbidities^†, n (%)
Allergic Conjunctivitis	65 (1.5%)	4 (1.5%)	8 (2.0%)	3 (0.8%)	43 (1.6%)	7 (1.2%)
Allergic Rhinitis	1053 (24.1%)	106 (39.3%)	136 (33.7%)	123 (33.0%)	572 (21.0%)	116 (19.6%)
Asthma	824 (18.9%)	82 (30.4%)	126 (31.3%)	101 (27.1%)	419 (15.4%)	96 (16.2%)
Atopic Dermatitis	151 (3.5%)	56 (20.7%)	28 (6.9%)	15 (4.0%)	43 (1.6%)	9 (1.5%)
Food Allergy	303 (6.9%)	81 (30.0%)	75 (18.6%)	44 (11.8%)	93 (3.4%)	10 (1.7%)
Hives/Urticaria	93 (2.1%)	19 (7.0%)	15 (3.7%)	6 (1.6%)	46 (1.7%)	7 (1.2%)
CRSwNP within 12 months	31 (0.7%)	0 (0%)	0 (0%)	2 (0.5%)	23 (0.8%)	6 (1.0%)
Any of the above	1653 (37.8%)	184 (68.1%)	226 (56.1%)	174 (46.6%)	883 (32.4%)	186 (31.4%)
Baseline Charlson-Quan score^†
Mean±SD	0.28±0.72	0.30±0.55	0.26±0.51	0.23±0.58	0.20±0.55	0.68±1.31
CCI (Categorical), n (%)
0	3507 (80.3%)	197 (73.0%)	311 (77.2%)	306 (82.0%)	2299 (84.2%)	394 (66.4%)
1-2	791 (18.1%)	70 (25.9%)	91 (22.6%)	63 (16.9%)	414 (15.2%)	153 (25.8%)
3	35 (0.8%)	3 (1.1%)	1 (0.2%)	2 (0.5%)	10 (0.4%)	19 (3.2%)
≥4	35 (0.8%)	0 (0%)	0 (0%)	2 (0.5%)	6 (0.2%)	27 (4.6%)
PreIndex Corticosteroid Use,^‡ n (%)
Oral (OCS)	862 (19.7%)	74 (27.4%)	77 (19.1%)	60 (16.1%)	522 (19.1%)	129 (21.8%)
Inhaled (ICS)	724 (16.6%)	102 (37.8%)	133 (33.0%)	99 (26.5%)	335 (12.3%)	55 (9.3%)
Topical (TCS)	450 (10.3%)	60 (22.2%)	44 (10.9%)	28 (7.5%)	236 (8.6%)	82 (13.8%)
PostIndex Corticosteroid Use,^§ n (%)
Oral (OCS)	676 (15.5%)	65 (24.1%)	61 (15.1%)	65 (17.4%)	397 (14.5%)	88 (14.8%)
Inhaled (ICS)	1556 (35.6%)	131 (48.5%)	189 (46.9%)	161 (43.2%)	942 (34.5%)	133 (22.4%)
Topical (TCS)	338 (7.7%)	45 (16.7%)	28 (6.9%)	23 (6.2%)	181 (6.6%)	61 (10.3%)
Data are mean ± standard deviation (SD) or n (%) unless otherwise indicated. *Based on federal poverty line (FPL) and measured during 1-year period prior to the index event (i.e., entry into the cohort with ≥1 inpatient or ≥2 outpatient claims and associated with an ICD9/ICD10 diagnosis for EoE). ^†Captured at any time during the 1-year period prior to index event, based on ICD9 or ICD10 codes. ^‡Captured at any time during the 1-year period prior to index event, based on National Drug Codes. ^§Captured at any time during the 1-year postindex period, based on National Drug Codes. Abbreviations: CCI, Charlson comorbidity index; CRwNP, chronic rhinosinusitis with nasal polyps; ER, emergency room; HCRU, healthcare resource utilization; ICD, International Classification of Diseases; ICS, inhaled corticosteroids; OCS, oral corticosteroids; TCS, topical corticosteroids.

Table: Table: Demographic and Clinical Characteristics of Patients with Eosinophilic Esophagitis (EoE)

Disclosures:

Sarah Naeger: Sanofi-Genzyme – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

Urvi Mujumdar: Sanofi-Genzyme – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

Kiran Patel: Sanofi-Genzyme – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

Arpita Nag: Sanofi-Genzyme – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

Eilish McCann: Regeneron Pharmaceuticals – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

Benjamin Ortiz: Regeneron Pharmaceuticals – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

Chao Chen: Regeneron Pharmaceuticals – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

Ledia Goga: Sanofi-Genzyme – Employee, Stockholder/Ownership Interest (excluding diversified mutual funds).

Sarah Naeger, PhD¹, Urvi Mujumdar, PhD¹, Kiran Patel, MD¹, Arpita Nag, PhD, MBA, MS, BPharm¹, Eilish McCann, PhD², Benjamin Ortiz, MD³, Chao Chen, PhD³, Ledia Goga, PhD⁴. P1367 - Steroid Exposure in Patients With Eosinophilic Esophagitis (EoE) From the United States, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.