- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01846962
Dietetic Versus Topical Steroids for Pediatric Eosinophilic Esophagitis
COMPARISON OF TREATMENT FOR PEDIATRIC EOSINOPHILIC ESOPHAGITIS: A RANDOMIZED CLINICAL TRIAL (DIETETIC Versus TOPICAL STEROIDS)
Therapeutic strategies for eosinophilic esophagitis (EoE) actually include: 1) allergen avoidance through dietary modifications, and 2) pharmacologic antiinflammatory therapy. Medical treatment is mainly based on topical administration of corticosteroids by swallowing fluticasone propionate or budesonide spray. Dietetic treatment with highest efficacy is elemental diet, consisting in exclusive feeding with amino-acid based formulas, often administered trough SNG. Alternative choices of acceptable efficacy are empirical six-foods elimination diet (cow's milk, egg, soy, wheat, peanuts, fish) and targeted elimination diet based on the results of allergy tests. Most of the paediatric patients with EE respond to elemental or targeted elimination diets, and therefore such authors recommend elimination diets to be considered the treatment of choice in children. However, elimination diets can often be complex to follow and may be associated with poor adherence owing to the low palatability of a highly restricted diet. In non-compliant patients, especially in adolescents and young adults, it may be more practical to proceed first with corticosteroid treatment. In the case of partial response to elimination diets or corticosteroids, a combination of both treatment mod. However, there has been limited testing of these regimens in randomized controlled trials, while most of available literature is based on case series.
The aim of this study was to compare the efficacy of six-foods elimination diet, swallowed fluticasone, swallowed budesonide and oral viscous budesonide (OVB) in pediatric patients with active EoE. The investigators assessed the effects of randomly assigned treatment on clinical and endoscopic/histologic severity as primary and secondary outcomes, respectively. The investigators describe clinical, allergological, endoscopic and histological features, and pH study results, of our pediatric population.
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Phase 4
Contacts and Locations
Study Locations
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Rome, Italy, 00161
- Departments of Pediatrics, Sapienza - University of Rome
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- suspected, or previously diagnosed, EoE in phase of clinical activity.
Diagnostic criteria were:
- suggestive esophageal symptoms (GERD-like disease, dysphagia, food impaction);
- a negative 24 hours pH-impedenzometric study or, whether positive, the refractoriness to a high dose proton pump inhibitor (PPI) therapy for at least 8 weeks;
- the histological demonstration of >15/20 eosinophils/HPF on at least 1 esophageal biopsy. Patients who received any dietetic or antiinflammatory treatment in the last 6 months were dropped out, and no allergy therapy was allowed during the study
Exclusion Criteria:
- diagnosis of concomitant inflammatory, rheumatic or infectious disease,
- and the assumption of any dietetic or therapy since the clinical onset.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: six-foods elimination diet
six-foods elimination diet.
The standard panel of foods tested included the 6 most common allergenic foods in childhood (cow's milk, egg, soy, wheat, peanuts, fish), plus foods that were suspiciously implicated in triggering an allergic reaction referred by patients or their parents.
Both perennial (dust mite, Parietaria, Alternaria, cat and dog dander) and seasonal (grass pollen including Graminaceae, Olea europea, Platanus) aeroallergens have been tested.
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six-foods elimination diet.
The standard panel of foods tested included the 6 most common allergenic foods in childhood (cow's milk, egg, soy, wheat, peanuts, fish), plus foods that were suspiciously implicated in triggering an allergic reaction referred by patients or their parents.
Both perennial (dust mite, Parietaria, Alternaria, cat and dog dander) and seasonal (grass pollen including Graminaceae, Olea europea, Platanus) aeroallergens have been tested.
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Experimental: fluticasone
The administered dose of topical steroid was 440mcg or 880mcg/day (<150 cm or >150 cm).
Patients were trained to swallow puffs and to non eat or drink fo 30 minutes after ingestion.
Patients noncompliant with therapy, monthly assessed by Pediatric Allergologists, were withdrawn from the study.
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The administered dose of topical steroid was 440mcg or 880mcg/day (<150 cm or >150 cm).
Patients were trained to swallow puffs and to non eat or drink fo 30 minutes after ingestion.
Patients noncompliant with therapy, monthly assessed by Pediatric Allergologists, were withdrawn from the study.
|
Experimental: Budesonide
The administered dose of topical steroid was 400mcg/day or 800 mcg/day (<150 cm or >150 cm).
Patients were trained to swallow puffs and to non eat or drink fo 30 minutes after ingestion.
Patients noncompliant with therapy, monthly assessed by Pediatric Allergologists, were withdrawn from the study.
|
The administered dose of topical steroid was 400mcg or 800mcg/day (<150 cm or >150 cm).
Patients were trained to swallow puffs and to non eat or drink fo 30 minutes after ingestion.
Patients noncompliant with therapy, monthly assessed by Pediatric Allergologists, were withdrawn from the study.
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Experimental: Oral Viscous Budesonide (OVB)
The administered dose of topical steroid was 1 or mg/day (<150 cm or >150 cm).
Patients were trained to prepare a homemade suspension of OVB prepared by mixing inhaled budesonide with viscous solutions of sodium alginate and to non eat or drink fo 30 minutes after ingestion.
Patients noncompliant with therapy, monthly assessed by Pediatric Allergologists, were withdrawn from the study.
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The administered dose of topical steroid was 1mg/day or 2mg/day (<150 cm or >150 cm).
Patients were trained to prepare a homemade suspension of OVB prepared by mixing inhaled budesonide with viscous solutions of sodium alginate and to non eat or drink fo 30 minutes after ingestion.
Patients noncompliant with therapy, monthly assessed by Pediatric Allergologists, were withdrawn from the study.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Efficacy Clinical Severity Score
Time Frame: 3 months
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The primary outcome measure was the Clinical Severity Score assessed at baseline (time 0) and after 3 months of treatment (time 1).
We scored each symptom basing on its frequency, intensity, and interference on life quality.
One point was added in the presence of feeding difficulties leading to growth delay (weight/heigth ratio <5° centile) or significant weight loss (>10% of initial body weight).
Two points were added the in case of gastrointestinal bleeding or severe strictures requiring urgent hospitalization.
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3 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Efficacy Severity Score for Endoscopy and Histology
Time Frame: 3 months
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Secondary outcome measurements were the Severity Score for Endoscopy and Histology assessed at time 0 and 1
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3 months
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Collaborators and Investigators
Sponsor
Study record dates
Study Major Dates
Study Start
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Digestive System Diseases
- Immune System Diseases
- Hypersensitivity, Immediate
- Hematologic Diseases
- Gastrointestinal Diseases
- Gastroenteritis
- Hypersensitivity
- Esophageal Diseases
- Leukocyte Disorders
- Eosinophilia
- Eosinophilic Esophagitis
- Esophagitis
- Physiological Effects of Drugs
- Autonomic Agents
- Peripheral Nervous System Agents
- Anti-Inflammatory Agents
- Glucocorticoids
- Hormones
- Hormones, Hormone Substitutes, and Hormone Antagonists
- Dermatologic Agents
- Bronchodilator Agents
- Anti-Asthmatic Agents
- Respiratory System Agents
- Anti-Allergic Agents
- Budesonide
- Fluticasone
Other Study ID Numbers
- Pediatric-EoE
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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