Higher Medication Possession Ratio Correlates with Improved Outcomes in Eosinophilic Esophagitis

Background: Eosinophilic esophagitis (EoE) is a relatively common, immune-mediated cause of esophageal inflammation and dysfunction in both children and adults. EoE disease activity can be due to medication non-adherence. We evaluated the association of medication possession ratio (MPR), an indirect marker of treatment adherence, and the outcomes of histologic remission, dysphagia, food impaction, stricture occurrence, and esophageal dilation in adults with EoE.

Methods: A preexisting EoE registry containing encounter notes, pathology reports, and medication data was retrospectively reviewed (2005 to 2020), and the number of treatment periods between endoscopies were determined. MPRs were then calculated for all included treatment periods. Medical records were assessed for histologic remission ( <15 eos/hpf), dysphagia, food impaction, stricture occurrence, and esophageal dilation that corresponded to each treatment period.

Results: 354 subjects yielded 275 individual treatment periods for analysis. With any treatment, the median MPR in the histologic remission group was 0.91 (IQR 0.63-1) vs. 0.63 (IQR 0.31-0.95) for the non-remission group (P <0.001). The optimal MPR cut-point for histologic remission was 0.7 (Sen 0.66, Spec 0.62, AUC 0.63). With MPRs ≥0.7, there were significantly increased odds of histologic remission (odds ratio 3.05, 95% CI 1.79-5.30) and decreased odds of dysphagia (OR 0.27, 95% CI 0.15-0.45), food impaction (OR 0.26, 95% CI 0.11-0.55), stricture occurrence (OR 0.52 95% CI 0.29-0.92), and esophageal dilation (OR 0.29, 95% CI 0.15-0.54).

Conclusion: Medication adherence, as measured by MPR, is associated with histologic remission and with decreased odds of dysphagia, impaction, stricture, and dilation in adults with EoE. Calculating MPR before a follow-up EGD to assess for response to EoE treatment may decrease unnecessary procedures. Although investigated using an adult database, this concept is not only applicable to the care of children with EoE, but also to children with other chronic diseases that have treatment-dependent outcomes.