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Introduction Eosinophilic oesophagitis (EoE) is a chronic immune-mediated condition requiring ongoing anti-inflammatory therapy. Budesonide orodispersible tablets (BOT) are licensed for induction and maintenance treatment, with current guidance recommending 0.5 mg twice daily for maintenance. In UK practice, varying regional prescribing constraints and patient preference frequently result in once-daily 1 mg dosing to avoid treatment gaps, although evidence supporting this pragmatic approach is limited. We evaluated the real-world effectiveness of once-daily 1 mg BOT as maintenance therapy in adult EoE.Methods We conducted a single-centre prospective observational cohort study (October 2023–November 2025) of adults with confirmed EoE who achieved histological remission <15 eosinophils/high-power field (phpf) following induction BOT and chose to take 1 mg once-daily maintenance. Disease activity was assessed using gastroscopy with EREFS scoring and histology. Symptoms were documented using the Dysphagia Symptom Questionnaire (DSQ) or direct symptom enquiry. Primary outcomes were histological and clinico-histological remission. Secondary endpoints included DSQ outcomes and phenotype-based comparisons.Results Thirty-six patients chose to be on once-daily 1 mg BOT maintenance (median age 47 years; 61% male). Median duration on maintenance before reassessment was 18 weeks (IQR 12–39). Histological remission was maintained in 30/36 (83.3%), clinical remission in 30/36 (83.3%), with clinico-histological remission in 27/36 (75.0%). 15 patients (41.7%) had an inflammatory and 21 (58.3%) a fibrostenotic phenotype. Histological remission occurred in 14/15 (93.3%) inflammatory versus 16/21 (76.2%) fibrostenotic patients (Fisher’s p=0.33). Clinico-histological remission was achieved in 13/15 (86.7%) versus 14/21 (66.7%), respectively (p=0.42). Treatment duration did not differ by phenotype (p=0.07).Conclusions In this real-world cohort once-daily 1 mg BOT maintained histological remission in over 80% of patients, including those with fibrostenotic disease. This supports dose de-escalation to a once-daily maintenance regimen that may be easier to implement in UK Gastroenterology and primary care practices and reduce treatment interruptions. Longer follow-up is required to confirm sustained treatment effectiveness.Abstract P148 Table 1Clinical and histological outcomes during once-daily 1 mg BOT (n=36)OutcomeInflammatory phenotype* (n=15)Fibrostenotic phenotype** (n=21)OGD total (n=36)Histological remission (<15 eos/hpf)14/15 (93.3%)16/21 (76.2%)30/36 (83.3%)Clinical remission (asymptomatic)14/15 (93.3%)16/21 (76.2%)30/36 (83.3%)Clinico-hwistological remission13/15 (86.7%)14/21 (66.7%)27/36 (75%)* Inflammatory phenotype: EREFS rings = 0 and strictures = 0.** Fibrostenotic phenotype: EREFS rings >0 and/or strictures >0.