A197 MEDICAL INTERVENTIONS IN EOSINOPHILIC ESOPHAGITIS (EOE): A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS (RCTS)
Bibliographic record
Abstract
Abstract Background Eosinophilic esophagitis (EoE) is a chronic, allergic/immune condition of esophagus characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. Aims Despite different drugs were studied for the treatment of EoE, there is no consensus on what the most effective medical interventions. We performed a systematic review and meta-analysis of RCTs to compare the efficacy of medical interventions in patients with EoE. Methods We searched MEDLINE, EMBASE and the Cochrane CENTRAL (via OvidSP) published from inception to November 01, 2018, to identify RCTs assessing the efficacy of medications (PPIs, steroids, anti-IL5 agents, anti-IL13 agents, anti-IL-4Rα agents and mast cell stabilizers) in patients with EoE. Outcomes were symptoms improvement and histology improvement. Studies that only reported continuous scores were excluded. Pooled risk ratios (RR) with 95% confidence intervals (CI), using a random effects model, were calculated. Results Among 1311 citations, 19 RCTs (n=1239 EoE cases) were included. 11 RCTs compared steroids vs placebo, two compared PPIs vs steroids, two compared anti- IL-13 vs placebo, two compared anti-IL-5 vs placebo, one compared anti-IL-4Rα vs placebo, and one compared mast cell stabilizer vs placebo. Steroids demonstrated significant improved in histology (63.3% vs 2.9%; RR 10.12, 95% CI 4.56–22.46) and improved EOE symptoms (39.6% vs 20.0%; RR =1.91, 1.16,3.14) compared to placebo. No difference was seen between oral and inhale steroids. No significant difference was seen between PPI vs prednisone either in symptom (RR 1.33, 0.36, 4.97) or in histology improvement (RR 1.83,0.76,4.40). Limited data suggest there is no significant difference between anti-IL-13 vs placebo; and anti-IL5 vs placebo; anti-IL-4Rα dupilumab but not mast cell stabilizer cromolyn may significantly improve histology compared to placebo. No substantial heterogeneity was seen in all analyses. Conclusions Current evidence suggests steroids significantly improve histology as well as symptoms in patients with EoE in compared to placebo. There is no significant difference between steroids and PPI. Data relate to other newer agents are limited. This meta-analysis highlights the variability in the interventions of EoE and the need for further studies to determine the optimal intervention. Funding Agencies None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.022 | 0.052 |
| Meta-epidemiology (narrow) | 0.004 | 0.002 |
| Meta-epidemiology (broad) | 0.026 | 0.040 |
| Bibliometrics | 0.010 | 0.008 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".