The following is a summary of the “Current state of biologics in treating eosinophilic esophagitis,” published in the January 2023 issue of Allergy and Clinical Immunology by Nhu et al.
When left untreated, eosinophilic esophagitis (EoE) causes fibro stenosis of the esophagus. EoE is a chronic, allergen-mediated, eosinophil-predominant, type 2 inflammatory illness. Treatment with biologics for EoE is the subject of this review. Relevant primary research, RCTs, systematic reviews, meta-analyses, case series, and case reports are chosen for synthesis and critique. Based on identifying important cytokines and mediators of eosinophilic inflammation and, more recently, type 2 inflammation that underlies EoE pathogenesis, biologics have been employed as exploratory therapy for EoE in clinical investigations over the years.
The monoclonal antibody dupilumab was recently licensed by the FDA for treating EoE; it works by blocking the binding of IL-4 and IL-13 to the (IL)-4Rα chain. Clinical symptoms, endoscopic scores, histologic inflammation, and esophageal distensibility were all enhanced by dupilumab treatment. Several active treatment trials focus on IL-5, IL-13, and thymic stromal lymphopoietin as potential targets in EoE.
It is generally agreed that the best ways to treat EoE are with a combination of proton pump inhibitor therapy, an elimination diet, dilatation, and topical corticosteroid application. The first treatment for EoE approved by the FDA is dupilumab. Additional research on the efficacy of biologics targeting eosinophils, critical cytokines, and inflammatory pathways in EoE is now underway. Emerging treatments for EoE will need to be strategically placed, and this calls for the development of treatment algorithms.
Source: sciencedirect.com/science/article/abs/pii/S1081120622018300