Satisfaction With and Adherence to Off-Label Corticosteroids in Adolescents and Adults With Eosinophilic Esophagitis: Results of a Web-Based Survey in the United States

J Clin Gastroenterol. 2025 Feb 1;59(2):138-146. doi: 10.1097/MCG.0000000000002006.

Abstract

Goals: We assessed satisfaction with and adherence to off-label corticosteroids in patients with eosinophilic esophagitis (EoE) in the United States.

Background: EoE is a chronic inflammatory disease for which there are currently no US Food and Drug Administration-approved swallowed topical corticosteroids.

Study: This noninterventional, cross-sectional, web-based survey included caregivers of adolescents (aged 11 to 17 y) and adults (aged 18 years or older) with a self-reported [or caregiver-reported (adolescents)] physician diagnosis of EoE who were receiving corticosteroids. Participants were recruited through 2 nonprofit, patient advocacy groups. The 9-item Treatment Satisfaction Questionnaire for Medication (TSQM-9) was used to assess satisfaction across effectiveness, convenience, and global satisfaction domains (scale: 1 to 100 per domain); higher scores indicated greater satisfaction. The 4-item Morisky Green Levine Medication Adherence Scale (MGL-4) was used to assess adherence; an MGL-4 score of <3 indicated adherence. Participants also reported reasons for nonadherence.

Results: Overall, 201 participants (caregivers of adolescents, n=98; adults, n=103) were included in this study. Mean TSQM-9 scores indicated low satisfaction with off-label corticosteroids across all 3 satisfaction domains in adolescents (≤61.1) and adults (≤55.7). Slightly fewer adolescents (37.1%) than adults (40.8%) were considered adherent. Forgetfulness was the most frequently reported reason for nonadherence; some patients chose not to take their medications, owing to poor palatability (adolescents), difficulty taking medications at specific times (adults), or feeling depressed/overwhelmed (adolescents and adults).

Conclusions: Satisfaction with and adherence to off-label corticosteroids were low in this web-based survey of adolescents and adults with EoE in the United States.

MeSH terms

  • Adolescent
  • Adrenal Cortex Hormones* / administration & dosage
  • Adrenal Cortex Hormones* / therapeutic use
  • Adult
  • Caregivers / psychology
  • Child
  • Cross-Sectional Studies
  • Eosinophilic Esophagitis* / drug therapy
  • Female
  • Humans
  • Internet
  • Male
  • Medication Adherence* / statistics & numerical data
  • Middle Aged
  • Off-Label Use* / statistics & numerical data
  • Patient Satisfaction* / statistics & numerical data
  • Surveys and Questionnaires
  • United States
  • Young Adult

Substances

  • Adrenal Cortex Hormones