INTRODUCTION: There is a need to understand how burden of disease, treatment patterns and disease progression vary in different age groups of patients with eosinophilic esophagitis (EoE) in a real-world setting.
METHODS: This retrospective observational cohort study used electronic medical records and claims data from the Geisinger Health System, an integrated health services network. Incident patients were eligible for inclusion if they had: at least two recorded diagnoses of EoE between August 1, 2009 and June 30, 2018; at least one upper endoscopy; and at least 12 months of data before (baseline) and after (follow-up) the study index date (date of the first endoscopy closest to, and between 180 days before and 365 days after the first diagnosis of EoE). Younger children, adults and older adults (0–11, 18–54 and ≥55 years old, respectively) with EoE were included in this analysis. We evaluated the differences in signs and symptoms of EoE, EoE-associated conditions, and treatment patterns before and after the index date. Healthcare resource utilization (HCRU; EoE-related and all-cause), including endoscopic procedures after the index date, were also evaluated.
RESULTS: Overall, 613 patients were enrolled; of these, 467 were 0–11 years old (n=182), 18–54 years old (n=244) or ≥55 years old (n=41), and met the inclusion criteria. Before and after the index date, abdominal pain and nausea/vomiting were more common in younger children than other groups; however, more adults and older adults than younger children reported dysphagia (Table 1). Pharmacologic treatment use for EoE was higher in older adults than other groups; the most commonly used off-label treatments were proton pump inhibitors and corticosteroids. The proportion of patients taking pharmacologic treatments increased after the index date (Figure 1). All patients had substantial HCRU (EoE-related and all-cause). Younger children consulted more specialists (Table 2) and had more endoscopies with biopsy in the 6 months after the index date than adults or older adults (73.6% vs 38.9% vs 31.7%). Generally, patients ≥18 years old had similar disease burdens and treatment patterns.
DISCUSSION: There were notable differences between age groups for signs and symptoms of EoE, EoE-associated conditions, treatment patterns and disease management practices. However, regardless of age, patients with EoE have substantial disease burden and high HCRU. These data highlight this unmet medical need and will help inform disease management in patients with EoE.
