Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis

Dellon, Evan S.; Rothenberg, Marc E.; Collins, Margaret H.; Hirano, Ikuo; Chehade, Mirna; Bredenoord, Albert J.; Lucendo, Alfredo J.; Spergel, Jonathan M.; Aceves, Seema S.; Sun, Xiyan; Kosloski, Matthew P.; Kamal, Mohamed; Hamilton, Jennifer D.; Beazley, Bethany; McCann, Eilish; Patel, Kiran Klaus; Mannent, Leda; Laws, Elizabeth; Akinlade, Bolanle; Amin, Nikhil; Lim, Wei Keat; Wipperman, Matthew F.; Ruddy, Marcella; Patel, Naimish; Weinreich, David R; Yancopouloš, George D.; Shumel, Brad; Maloney, Jennifer; Giannelou, Angeliki; Shabbir, Arsalan

doi:10.1056/nejmoa2205982

Cited by 171 publications

(115 citation statements)

References 33 publications

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“…Dupilumab has been used extensively in a variety of conditions, and overall demonstrates a generally favorable adverse effect profile. As mentioned previously, the main adverse effects in the EoE trials were largely local erythema or injection site reactions 29–33 . This is also consistent with use in asthma and atopic dermatitis 23,33 .…”

Section: Biologic Therapiessupporting

confidence: 80%

Emerging therapies for eosinophilic esophagitis

Meek

Hemstreet

2023

Pharmacotherapy

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Eosinophilic esophagitis (EoE) is an inflammatory condition of the esophagus that is quickly becoming a more recognized cause of esophageal dysfunction and dysphagia. The cause of EoE is thought to be due to an inflammatory response triggered by exposure to dietary or environmental antigens. Symptoms may be progressive and include reflux, nausea, vomiting, dysphagia, and reduction in quality of life. Both children and adults may be affected. Initial treatments for EoE have focused on elimination diets to potentially identify and remove dietary triggers, acid suppression with proton pump inhibitors, and topical delivery of orally administered swallowed corticosteroids. These therapies are often ineffective in a large proportion of patients, leading to exploration of other approaches by focusing on cytokines involved in the inflammatory response. Most recently, dupilumab, a monoclonal antibody targeting IL‐4 received approval for use in patients aged 12 years or older with EoE. Use of dupilumab has seen favorable improvements in disease progression and symptoms with chronic use. Other therapies targeting IL‐5, such as mepolizumab, reslizumab, and benralizumab are currently being studied for use in EoE. Therapies targeting other key inflammatory mediators in EoE, such as Siglec‐8 (lirentelimab), IL‐13 (cendakimab), and the sphingosine 1‐phosphate receptor (etrasimod) are currently being evaluated in clinical trials.

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Section: Biologic Therapiessupporting

confidence: 80%

Emerging therapies for eosinophilic esophagitis

Meek

Hemstreet

2023

Pharmacotherapy

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“…Dupilumab was approved by the FDA in April 2017 for the treatment of adult patients with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. 3 It is also reported to treat prurigo nodosa, 4 , 5 bullous pemphigoid, 6 eosinophilic esophagitis, 7 , 8 asthma, 9 etc.…”

Section: Discussionmentioning

confidence: 99%

Hypereosinophilic Dermatitis: Successful Treatment with Dupilumab

Wu¹,

Zhang²,

Zhao³

2023

BTT

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Hypereosinophilic dermatitis (HED) is a subtype of hypereosinophilic syndrome. HED is characterized by eosinophilic granulocytes increased in peripheral blood and bone marrow and infiltrated in skin. The clinical manifestations of HED are diffussed by erythema, papule and maculopapule with severe itching. The etiology of HED is unknown. At present, in addition to HED with FIP1L1-PDGFRA fusion gene positive, whose treatment is tyrosine kinase inhibitor, other types of HED first-line treatment are oral glucocorticoids, supplemented by antihistamines and immunosuppressants. Dupilumab is a human monoclonal antibody, which inhibits the IL-4 and IL-13 signaling by binding to the IL-4R-α and IL-13R-α-1 subunits of the receptor. We report a 76-year-old male patient with HED whose peripheral blood eosinophils decreased from 20.7% to 4.1% after 8 weeks of dupilumab, and his pruritus was completely relieved. Dupilumab was discontinued after 6 months of treatment. It is exciting that the patient has not experienced relapse for 17 months after the discontinuation. No adverse event was reported.

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“…The recommended dose is 300 mg per week [ 91 ]. The latest randomized controlled trial on dupilumab showed that the majority of patients taking this drug at a weekly dose of 300 mg had statistically significant improvements in histologic outcomes and reductions in symptoms of eosinophilic esophagitis compared to the placebo [ 92 ]. One of the indications for dupilumab in EoE, apart from atopic diseases, is a severe form of the disease, i.e., patients with clinically significant esophageal strictures and those with failure to thrive, weight loss, or growth impairment due to EoE [ 93 ].…”

Section: Treatmentmentioning

confidence: 99%

Eosinophilic Esophagitis—What Do We Know So Far?

Wąsik

Małecka-Wojciesko

2023

JCM

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Eosinophilic esophagitis is a Th-2 antigen-mediated disease in which there is an influx of eosinophils to all layers of the esophagus, triggering an inflammatory response. Chronic inflammatory process causes esophageal remodeling, leading to difficulties in swallowing. Food impaction, heartburn, and chest pain are other characteristic (but not pathognomonic) symptoms in adults. Although the disease has only been described since in the early 1970s, its incidence and prevalence are rapidly growing, especially in Western countries. According to the diagnostic guidelines, there should be at least 15 eosinophils visible per high-power field in biopsies obtained from different sites in the esophagus upon endoscopy with relevant esophageal symptoms. Other diseases that can cause esophageal eosinophilia should be ruled out. Eosinophilic esophagitis treatment may be challenging; however, new methods of management have recently emerged. The currently used proton pump inhibitors, topical corticosteroids, and elimination diet are combined with biological treatment. New methods for disease diagnostics and clinical course assessment are also available. This review presents current knowledge about the disease, supported by the latest research data.

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Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis

Cited by 171 publications

References 33 publications

Emerging therapies for eosinophilic esophagitis

Emerging therapies for eosinophilic esophagitis

Hypereosinophilic Dermatitis: Successful Treatment with Dupilumab

Eosinophilic Esophagitis—What Do We Know So Far?

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