A recent systematic review and meta-analysis found that prolonged therapy in eosinophilic esophagitis is safe and effective for preventing long-term histologic relapse. Both biologics and swallowed topical corticosteroids showed similar efficacy in maintaining remission, while proton pump inhibitors demonstrated favorable results in observational studies.

Across 23 studies including 1,819 patients, corticosteroids achieved 86% histologic remission and biologics 79%, with dupilumab at 82%. Budesonide was strongly associated with sustained remission versus withdrawal, and therapy deescalation did not trigger relapse. Proton pump inhibitors achieved 64% histologic and 80% clinical success, compared with lower rates for corticosteroids in observational data.

Long-term safety was confirmed, with severe adverse events reported in 3% of randomized trial patients and 5% in observational studies. 

Source: Clinical Gastroenterology and Hepatology