INTRODUCTION: This retrospective observational cohort study assessed the diagnostic journey, burden of disease and treatment patterns in patients with eosinophilic esophagitis (EoE) in a real-world setting.
METHODS: This study used electronic medical records and claims data from the Geisinger Health System. Incident patients were eligible for inclusion if they had: at least two diagnoses of EoE between August 1, 2009 and June 30, 2018; at least one endoscopy; at least 12 months of data before (baseline) and after (follow-up) the study index date (date of the endoscopy closest to, and between 180 days before and 365 after the first diagnosis of EoE). We evaluated the diagnostic journey and disease progression in patients with EoE, and assessed signs and symptoms of EoE, EoE-associated conditions and treatment patterns before and after the index date. All-cause healthcare resource utilization (HCRU) and the proportion of patients undergoing upper endoscopies with biopsy after the index date were also evaluated.
RESULTS: Overall, 613 patients were enrolled; the mean (standard deviation) age was 24.2 (17.8) years and most were male (65.3%). Outcomes that illustrate the journey experienced by patients with EoE are summarized (Table 1). The most common signs and symptoms and EoE-associated conditions before and after the index date were dysphagia, abdominal pain and gastroesophageal reflux disease. The prevalence of all signs and symptoms and EoE-associated conditions increased after the index date (Figure 1). The most commonly used off-label pharmacologic treatments before and after the index date were proton pump inhibitors (PPIs); PPIs were initiated sooner after the index date than other pharmacologic treatments. Pharmacologic treatment use increased after the index date (data not shown). Patients had substantial HCRU; more than half had all-cause emergency department visits and nearly 1 in 5 had an all-cause inpatient admission. Patients also had consultations with multiple specialists (Table 2). Upper endoscopies with biopsy were performed in 23.7% and 55.0% of patients up to 3 and 6 months after the index date, respectively.
DISCUSSION: After diagnosis, patients with EoE exhibit substantial disease burden, high HCRU and increased pharmacologic treatment use. Despite this, only half of all patients had a post-index upper endoscopy with biopsy to evaluate treatment response 6 months after the index date. These data help outline the diagnostic journey, unmet patient needs, and natural history of EoE.
