Dellon ES, Goodwin B, Lee L, Korgaonkar S, Meyers J, Schaeffer-Koziol C, Terreri B, Shah E. Patients receiving budesonide oral suspension (BOS) in real-world practice have more severe eosinophilic esophagitis (EOE) at baseline than those not receiving BOS: results from a retrospective cohort study using US health insurance claims data. Poster presented at the Digestive Disease Week (DDW) 2026; May 5, 2026. Chicago, IL.

INTRODUCTION: Eosinophilic esophagitis (EoE), if inadequately treated, can progress from an inflammatory to a more severefibrostenotic phenotype. There is thus growing interest in understanding the effect of EoE severity on theburden of disease and treatment options and outcomes.

METHODS: Data from the Merative MarketScan Commercial, Medicare Supplemental and Medicaid databases over 4.5years (July 1, 2020–December 31, 2024) were analyzed in a retrospective, observational cohort study. Patientswere eligible for inclusion in the overall EoE cohort if they had ≥1 inpatient/outpatient claim for EoE (index date:date of first claim between July 1, 2021 and December 31, 2023) and 12 months of continuous health planenrollment both before and after the index date (baseline and follow-up periods, respectively). Patients in thebudesonide oral suspension (BOS; US Food and Drug Administration-approved medication) cohort required ≥1claim for BOS (index date: date of first claim), ≥1 inpatient/outpatient claim for EoE (at any point in time) and12 months and ≥30 days of continuous health plan enrollment before and after the index date, respectively(baseline and follow-up periods, respectively). Patients with eosinophilic gastritis/gastroenteritis at any point intime were excluded. Using a previously developed claims-based algorithm (based on the Index of Severity forEoE [I-SEE]), patients were classified as having mild, moderate or severe disease based on the EoE-relateddiagnoses, procedures and complications identified in the baseline period + 30 days after the index date.Demographics and clinical characteristics for both cohorts were recorded at baseline.

RESULTS: Of 34,743 patients identified with EoE, disease severity was mild, moderate and severe in 66.2%, 27.6% and6.2% of patients, respectively. Among the 339 patients receiving BOS, there was a shift from mild to moderateseverity (mild, 50.1%; moderate, 44.8%; severe, 5.0%; Figure ) when compared with all patients. Patientdemographics and clinical characteristics at baseline are shown in Table . During baseline, dysphagia and acidreflux were more common in patients receiving BOS (61.4% and 51.0%, respectively) than not receiving BOS(33.2% and 38.3%, respectively). Similarly, during baseline, esophageal strictures and dilations were morecommon in patients receiving BOS (35.7% and 32.4%, respectively) than not receiving BOS (9.1% and 6.7%,respectively).

DISCUSSION: Patients receiving BOS were more likely to have moderate disease than the overall EoE cohort. Duringbaseline, they were also more likely to have signs and symptoms related to EoE and esophageal strictures anddilations. These findings suggest that in real-world practice, BOS is being used for patients with more severeEoE, despite guideline recommendations for topical corticosteroids as a first-line treatment option.