title: Systematic review with network meta-analysis: comparative effectiveness of topical steroids vs. PPIs for the treatment of the spectrum of eosinophilic oesophagitis.
abstract: BACKGROUND
  Controversy surrounds the clinical and histological response to topical steroids in patients with eosinophilic oesophagitis (EoE).
  
  
  OBJECTIVE
  To perform a systematic review and network meta-analysis of randomised controlled trials to assess the efficacy of topical steroids compared with placebo or proton pump inhibitor (PPIs) for the management of eosinophilic oesophagitis.
  
  
  METHODS
  Cochrane Central Register of Controlled Trials and MEDLINE from inception to 1 July 2015 was searched. Data were extracted independently by two authors. Methodological quality was assessed using the Cochrane risk of bias tool. A network meta-analysis was performed using the Bayesian methods under random-effects multiple treatment comparisons. Results were summarised as odds ratio along with credibility intervals. We also calculated the ranking probability for each treatment based on surface under the cumulative ranking curve (SUCRA).
  
  
  RESULTS
  The overall methodological quality of included studies was low. SUCRA ranking probability indicated that PPI had the highest probability of being the best treatment for achieving histological remission and mean change in eosinophils (0.81 and 0.85, respectively), followed by budesonide (0.74 and 0.63, respectively) and fluticasone (0.5 and 0.5, respectively). None of the comparisons indicated a statistically signicant difference.
  
  
  CONCLUSIONS
  The results from network meta-analysis show that there is no statistically significant difference between PPI, budesonide and fluticasone for the treatment of EoE as assessed by the histological and clinical response. The evidence is limited by serious risk of bias and imprecision, which emphasises the urgent need for large RCTs with adequate sample size and methodological rigour to provide conclusive evidence.
authors.affiliation: Division of Digestive Diseases and Nutrition, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Lipka
authors.affiliation: Division of Evidence Based Medicine and Outcomes Research, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Division of Evidence Based Medicine and Outcomes Research, Department of Medicine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: B
authors.initials: B
authors.lastname: Miladinovic
authors.affiliation: Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Richter
mesh_terms: D001499:Bayes Theorem; D019819:Budesonide / Q000627:therapeutic use; D004333:Drug Administration Routes; D057765:Eosinophilic Esophagitis / Q000188:drug therapy*; D000068298:Fluticasone / Q000627:therapeutic use; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D013256:Steroids / Q000627:therapeutic use*
chemical_list: D054328:Proton Pump Inhibitors; D013256:Steroids; D019819:Budesonide; D000068298:Fluticasone