INTRODUCTION: Although there are currently no FDA-approved therapies for eosinophilic esophagitis (EoE), guidelines recommend the use of off-label topical corticosteroids as first-line therapy. These can be expensive and inconvenient, which may affect treatment adherence and result in suboptimal outcomes in patients with EoE. This study evaluated patient satisfaction and adherence to current corticosteroid treatments in adolescents and adults with EoE.
METHODS: This was a non-interventional, cross-sectional, web-based survey of adolescents (11–17 years old; caregiver-reported) and adults (≥ 18 years old) in the USA with a caregiver- or self-reported physician diagnosis of EoE who were currently using any liquid, aerosol or tablet-based corticosteroid formulation for EoE. Patients were recruited from two non-profit advocacy groups: American Partnership for Eosinophilic Disorders (between July 29 and October 30, 2020) and Campaign Urging Research for Eosinophilic Diseases (between November 17, 2020 and February 28, 2021). Corticosteroid treatment satisfaction and adherence were assessed using the 9-item Treatment Satisfaction Questionnaire for Medication (TSQM-9; three domains: effectiveness, convenience and global satisfaction; scores range from 0–100; higher scores indicate greater satisfaction) version 1.4 and the Morisky Green Levine Medication Adherence Scale (MGL; scores range from 0–16; scores of < 3 indicate adherence).
RESULTS: Overall, 201 participants (adolescents, n = 98; adults, n = 103) completed the survey. The proportions of participants receiving different corticosteroid treatments for EoE were similar between age groups. MeanTSQM-9 scores indicated low treatment satisfaction across the three domains, with slightly higher satisfaction observed in adolescents than adults. Based on MGL total scores, only 39.0% of patients overall were adherent to their corticosteroid medication; this was similar by age group. Overall, 46.3% had not taken their medication every day over the past 7 days, with a mean of 2.2 days missed. The most common reason for missing medication was ‘the medicine tastes bad’ (55.6%) in adolescents, and ‘difficulty taking it at a specific time’(31.3%) and feeling ‘depressed/overwhelmed’ (31.3%) in adults.
DISCUSSION: Satisfaction and adherence to corticosteroid medication was low in patients with EoE; these findings demonstrate an unmet need for a standardized, convenient corticosteroid treatment option for EoE.
