P0331 - Patient Satisfaction and Adherence to Corticosteroids in Adolescents and Adults With Eosinophilic Esophagitis in a Real-World Setting in the U.S.

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Benjamin D. Gold, MD, FACG

Children’s Center for Digestive Healthcare, LLC, GI Care for Kids
Atlanta, GA, United States

Benjamin D. Gold, MD, FACG¹, Bridgett Goodwin, MS², Kimberly Davis, MS³, Carolyn Sweeney, MPH³, Ryan Ziemiecki, MS³, Jeanne Jiang, PhD⁴, Tao Fan, PhD, MS⁴, Mena Boules, MD⁴, Nirav K. Desai, MD², David A. Katzka, MD⁵
¹Children’s Center for Digestive Healthcare, LLC, GI Care for Kids, Atlanta, GA; ²Takeda Development Center Americas, Inc., Cambridge, MA; ³RTI Health Solutions, Research Triangle Park, NC; ⁴Takeda Pharmaceuticals USA, Inc., Lexington, MA; ⁵Mayo Clinic, Rochester, MN

Introduction: Although there are currently no FDA-approved therapies for eosinophilic esophagitis (EoE), guidelines recommend the use of off-label topical corticosteroids as first-line therapy. These can be expensive and inconvenient, which may affect treatment adherence and result in suboptimal outcomes in patients with EoE. This study evaluated patient satisfaction and adherence to current corticosteroid treatments in adolescents and adults with EoE.

Methods: This was a non-interventional, cross-sectional, web-based survey of adolescents (11–17 years old; caregiver-reported) and adults (≥ 18 years old) in the USA with a caregiver- or self-reported physician diagnosis of EoE who were currently using any liquid, aerosol or tablet-based corticosteroid formulation for EoE. Patients were recruited from two non-profit advocacy groups: American Partnership for Eosinophilic Disorders (between July 29 and October 30, 2020) and Campaign Urging Research for Eosinophilic Diseases (between November 17, 2020 and February 28, 2021). Corticosteroid treatment satisfaction and adherence were assessed using the 9-item Treatment Satisfaction Questionnaire for Medication (TSQM-9; three domains: effectiveness, convenience and global satisfaction; scores range from 0–100; higher scores indicate greater satisfaction) version 1.4 and the Morisky Green Levine Medication Adherence Scale (MGL; scores range from 0–16; scores of < 3 indicate adherence).

Results: Overall, 201 participants (adolescents, n = 98; adults, n = 103) completed the survey. The proportions of participants receiving different corticosteroid treatments for EoE were similar between age groups (Table). Mean TSQM-9 scores indicated low treatment satisfaction across the three domains, with slightly higher satisfaction observed in adolescents than adults (Figure). Based on MGL total scores, only 39.0% of patients overall were adherent to their corticosteroid medication; this was similar by age group. Overall, 46.3% had not taken their medication every day over the past 7 days (Table), with a mean of 2.2 days missed. The most common reason for missing medication was ‘the medicine tastes bad’ (55.6%) in adolescents, and ‘difficulty taking it at a specific time’ (31.3%) and feeling ‘depressed/overwhelmed’ (31.3%) in adults.

Discussion: Satisfaction and adherence to corticosteroid medication was low in patients with EoE; these findings demonstrate an unmet need for a standardized, convenient corticosteroid treatment option for EoE.

Figure: Figure. Patient satisfaction with their current corticosteroid treatments in adolescents* and adults with EoE

Corticosteroid treatment satisfaction was assessed using the TSQM-9 version 1.4; scores are in the range 0–100, with higher scores indicating greater satisfaction.
*Minor changes to the wording of the TSQM-9 were made for the adolescent survey to apply to a caregiver’s perspective.
EoE, eosinophilic esophagitis; TSQM-9, 9-item Treatment Satisfaction Questionnaire for Medication.

Category	Adolescents (n = 98)	Adults (n = 103)	Overall (N = 201)
Which of the following medications are you [is your child] currently taking to treat EoE?^†
Budesonide liquid (compounded)	5 (5.1)	6 (5.8)	11 (5.5)
Budesonide slurry	43 (43.9)	33 (32.0)	76 (37.8)
Budesonide oral inhaler	4 (4.1)	7 (6.8)	11 (5.5)
Fluticasone oral inhaler	39 (39.8)	41 (39.8)	80 (39.8)
Prednisone	4 (4.1)	11 (10.7)	15 (7.5)
Other^‡	3 (3.1)	5 (4.9)	8 (4.0)
Over the past 7 days, did you [your child] at any time forget to take or choose not to take [insert name of treatment] to treat your [his/her] EoE? Please select all that apply
Yes, I forgot to take my treatment^†	37 (37.8)	40 (38.8)	77 (38.3)
Yes, I chose not to take my treatment^†	9 (9.2)	16 (15.5)	25 (12.4)
No, I took every day over the past 7 days	55 (56.1)	53 (51.5)	108 (53.7)
Over the past 7 days, how many days did you [your child] forget or choose not to take your [his/her] treatment?
n	43	50	93
Mean (SD)	2.0 (1.4)	2.3 (1.6)	2.2 (1.5)
Why did you [your child] choose not to take [insert name of treatment] to treat your [his/her] EoE over the past 7 days? Please select all that apply.
n	9	16	25
My [His/her] EoE symptoms have not been bothersome	3 (33.3)	4 (25.0)	7 (28.0)
I [He/she] felt okay, so I did not think it was necessary to take the medicine daily	3 (33.3)	3 (18.8)	6 (24.0)
[My child thinks the] The medicine tastes bad	5 (55.6)	0 (0.0)	5 (20.0)
I have difficulty taking it [giving it to my child] at the specific time I am [he/she is] supposed to take it	1 (11.1)	5 (31.3)	6 (24.0)
I [He/she] had too many other pills/medications to take	1 (11.1)	3 (18.8)	4 (16.0)
It is not effective at controlling my [my child’s] EoE symptoms	0 (0.0)	2 (12.5)	2 (8.0)
I [He/she] experienced side effects from the medicine	2 (22.2)	3 (18.8)	5 (20.0)
The medicine is expensive	0 (0.0)	2 (12.5)	2 (8.0)
The medicine is difficult or inconvenient to get from the pharmacy in a timely manner	0 (0.0)	2 (12.5)	2 (8.0)
I did not have the medicine available (e.g. away from home, on vacation)	0 (0.0)	2 (12.5)	2 (8.0)
I [My child] just needed a break	1 (11.1)	2 (12.5)	3 (12.0)
I [My child] felt depressed/overwhelmed	4 (44.4)	5 (31.3)	9 (36.0)
Other	3 (33.3)	3 (18.8)	6 (24.0)

Table: Table. Patient Adherence to their Current Corticosteroid Treatments in Adolescents* (Caregiver-Reported) and Adults (Self- Reported) with EoE

Data are n (%) unless otherwise specified. Corticosteroid treatment adherence was assessed using the MGL; data presented are responses to questions from the MGL.
*Minor changes to the wording of the MGL were made for the adolescent survey to apply to a caregiver’s perspective; all differences in wording are shown in brackets.
†Categories were not mutually exclusive.
‡Other medications included: beclomethasone nasal or oral inhaler, flunisolide nasal or oral inhaler, mometasone oral inhaler or triamcinolone acetonide oral inhaler.
EoE, eosinophilic esophagitis; MGL, Morisky Green Levine Medication Adherence Scale; SD, standard deviation.

Disclosures:

Benjamin Gold: DiaSorin Molecular, LLC – Consultant, Other Financial or Material Support, Participates in continuing medical education activities. Evolve BioSystems, Inc. – Consultant, Other Financial or Material Support, Participates in continuing medical education activities. Johnson & Johnson (Janssen) – Consultant, Other Financial or Material Support, Participates in continuing medical education activities. Mead Johnson Nutrition – Consultant, Other Financial or Material Support, Participates in continuing medical education activities. Nestlé USA – Consultant, Other Financial or Material Support, Participates in continuing medical education activities. Nutricia North America – Consultant, Other Financial or Material Support, Participates in continuing medical education activities. Takeda Pharmaceutical Company Limited – Consultant, Other Financial or Material Support, Participates in continuing medical education activities.

Bridgett Goodwin: Takeda Development Center Americas, Inc. – Employee. Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds).

Kimberly Davis: RTI Health Solutions – Employee. Takeda Pharmaceutical Company Limited – Grant/Research Support.

Carolyn Sweeney: RTI Health Solutions – Employee. Takeda Pharmaceutical Company Limited – Grant/Research Support.

Ryan Ziemiecki: RTI Health Solutions – Employee. Takeda Pharmaceutical Company Limited – Grant/Research Support.

Jeanne Jiang: Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds). Takeda Pharmaceuticals USA, Inc. – Employee.

Tao Fan: Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds). Takeda Pharmaceuticals USA, Inc. – Employee.

Mena Boules: Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds). Takeda Pharmaceuticals USA, Inc. – Employee.

Nirav Desai: Takeda Development Center Americas, Inc. – Employee. Takeda Pharmaceutical Company Limited – Stockholder/Ownership Interest (excluding diversified mutual funds).

David Katzka: Receptos/Celgene – Consultant. Shire, a Takeda company – Grant/Research Support.

Benjamin D. Gold, MD, FACG¹, Bridgett Goodwin, MS², Kimberly Davis, MS³, Carolyn Sweeney, MPH³, Ryan Ziemiecki, MS³, Jeanne Jiang, PhD⁴, Tao Fan, PhD, MS⁴, Mena Boules, MD⁴, Nirav K. Desai, MD², David A. Katzka, MD⁵. P0331 - Patient Satisfaction and Adherence to Corticosteroids in Adolescents and Adults With Eosinophilic Esophagitis in a Real-World Setting in the U.S., ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.