Dupilumab improves clinical and histologic features of eosinophilic esophagitis prior to 12 weeks of treatment DOI Creative Commons
Twan Sia,

Amanda Miller,

Leeon Bacchus

и другие.

Clinical and Translational Allergy, Год журнала: 2024, Номер 14(1)

Опубликована: Янв. 1, 2024

Dupilumab is a human monoclonal antibody against interleukin-4 receptor alpha subunit. an approved treatment for inducing remission of eosinophilic esophagitis (EoE).1 EoE histologic with dupilumab has only been demonstrated in patients after at least 12 weeks treatment.2-6 Current guidelines recommend waiting re-evaluation until 20–24 dupilumab.1 It unknown if increasing length improves its efficacy. Because requires invasive biopsies, and important to prevent progressive esophageal damage, research investigating the effects on prior warranted. We conducted retrospective study single medical clinic. The electronic record was searched between 2017 2023 using International Classifications Disease, 10th revision code K20.0 esophagitis. excluded who had (1) never started dupilumab; (2) no confirmation defined by ≥ 15 eos/hpf; or (3) while dupilumab. Histologic evaluation assessed 2 biopsies each proximal, middle, distal esophagus. Endpoints were peak eosinophil counts (eosinophils per high-power field; eos/hpf), endoscopic reference scores (EREFS), composite symptom score which (dysphagia, food impaction/choking, regurgitation/vomiting, heartburn/chest pain, abdominal pain) graded (0 = absent, 1 mild, moderate, 3 severe) summed. This deemed exempt from institutional review board approval WCG IRB. From record, 658 identified, 534 initiated dupilumab, 6 did not have EoE, 39 repeat initiation. Therefore, 79 included this study. median age 27.6 years (Q1 Q3, 21.8–36.1), 48 (60.8%) male, (15.2%) pediatric (Table 1). Sixty (75.9%) atopic comorbidity, including allergic rhinitis (43 patients, 54.4%), asthma (27 34.2%), dermatitis (13 16.5%), allergies (30 38.0%). Patients 22.7 16–26.7). Dosages 300 mg every week (71 89.9%), other loading dose 600 (7 8.9%), 200 400 (1 patient, 1.3%). Of 0–12 weeks. 5.5 4–6), significantly decreased 0 0–1; Wilcoxon matched-pairs signed rank test, p 0.000488) Median 44.5 eos/hpf 32.5–53.5) baseline 0–15.5; 0.000977) Endoscopic available (19%) our cohort. In weeks, EREFS decrease (median, 2; Q1 1–4) versus 0; 0–1.5; 0.25). However, change also insignificant 12–24 (p 0.13), greater than 24 0.25), suggesting insignificance may be due low n. induce clinical benefit treatment. There significant differences changes 0.1350), count 0.0746); 0.8771) 12, 12–24, terms response, 9 (75%) histologically responsive group, 28 (73.7%) 26 (89.7%) longer group. difference proportion response groups (Fisher's exact 0.2569). Subanalysis 7 >1 evaluations summarized Figure 1. Three unresponsive early timepoints (Patient 4 Patient 5 weeks) without addition combination therapy. contrast, remained over therapy omeprazole mometasone, respectively. their Our subanalysis suggests that certain are EGDs respond later timepoints. Further needed predict EGDs. Swimmer plot multiple * indicates mometasone 1.6 twice daily. ** 20 once *** mg, as opposed week. conclusion, induced before treatment, there clinical, histologic, 2–24 beneficial identify earlier previous indicate.1 should investigate appropriate window performed. Twan Sia: Conceptualization (equal); data curation formal analysis investigation methodology validation visualization writing—original draft writing—review editing (equal). Amanda Miller: Data Leeon Bacchus: Jennie Young: Aditya P. Narayan: Rachel Solecki: Investigation Jerry Fu: Yuting Jiang: Raisa Khuda: Stanley Liu: Kathleen Love: Shibani Mallik: Amina Sara Matmatte: Paige McDonald: Tanvi Telukunta: Alyssa Roby: Saad Shami: Michelle Zheng: Madison Headen: John Leung: project administration resources supervision None. consultant Devine; Millimet Branch Professional Education; Sanofi; Huron Consulting Services LLC; Takeda; Ribon Therapeutics; Tegus; Slingshot; Guidepoint; Cowen; AstraZeneca; Regeneron; AbbVie. None authors relevant conflicts interests disclose. received specific grant any funding agency public, commercial, not-for-profit sectors. All de-identified materials stored HIPPA-compliant, password-protected, cloud-based storage. Access these files will provided upon reasonable request corresponding author, Leung.

Язык: Английский

Contribution of T cell subsets to different food allergic diseases DOI Creative Commons
Lisa Hung,

Brianna Zientara,

M. Cecilia Berin

и другие.

Immunological Reviews, Год журнала: 2024, Номер 326(1), С. 35 - 47

Опубликована: Июль 25, 2024

Food allergies occur due to a lack of tolerance the proteins found in foods. While IgE- and non-IgE-mediated food have different clinical manifestations, epidemiology, pathophysiology, management, they share dysregulated T cell responses. Recent studies shed light on contributions subsets development persistence allergic diseases. This review discusses role cells both considers potential future investigations this context.

Язык: Английский

Процитировано

4
La esofagitis eosinofílica. Conceptos actuales de la fisiopatología, del diagnóstico y del tratamiento DOI Creative Commons
Diego García‐Compeán, Alan Rafael Jiménez-Rodríguez,

C.E. González-Martínez

и другие.

Revista de Gastroenterología de México, Год журнала: 2025, Номер unknown

Опубликована: Янв. 1, 2025

Процитировано

0
Eosinophilic esophagitis in the “atopic march”: dupilumab as an “umbrella” strategy for multiple coexisting atopic diseases DOI Creative Commons

Nicola Lutzu,

Agnese Favale, M. Demurtas

и другие.

Frontiers in Medicine, Год журнала: 2025, Номер 11

Опубликована: Янв. 21, 2025

Dupilumab is a monoclonal antibody targeting interleukin-4 and interleukin-13, approved for the treatment of multiple T2 diseases more recently Eosinophilic Esophagitis (EoE). EoE chronic inflammatory disease, believed to be member “atopic march”, due similarities with other atopic diseases, ranging from epidemiology genetics pathophysiology. Although often co-existing in same patient, these are still treated as separated entities by different specialists, resulting polypharmacy use steroids. Thus, shared-decision approach multidisciplinary team composed specialists might improve clinical management outcomes. Yet, prospective data on effectiveness dupilumab single agent lacking, since only few case reports small studies have been published so far reporting outcomes patients affected diseases. The purpose this review illustrate rationale evidence supporting possibility using therapeutic those addition EoE.

Язык: Английский

Процитировано

0
Dupilumab in children with eosinophilic esophagitis: a retrospective multicenter study DOI Creative Commons
Mohammed Hasosah,

Ghassan Sukkar,

Asharf AlSahafi

и другие.

BMC Pediatrics, Год журнала: 2025, Номер 25(1)

Опубликована: Фев. 5, 2025

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. Dupilumab human monoclonal antibody that targets both IL-4 IL-13 signaling. It currently indicated for the treatment asthma, atopic dermatitis, EoE. This study aimed to describe children with EoE difficult treat using conventional identify symptomatic, histological, endoscopic improvements after dupilumab treatment. We conducted retrospective multicenter in confirmed performed chart review patients prescribed Demographic information, symptoms, medications including were collected. The findings, histopathological features, results analyzed. calculated change reference scoring system (EREFS) scores from baseline 3 months. Eleven included this study. population comprised seven boys (64%) four girls (36%). median age at presentation was 11.6 years (8–13 years). dose 200–300 mg administered all as second-line therapy refractory (proton pump inhibitors, corticosteroids, dietary restrictions). efficacy regarding symptom relief, histological 82%, 73%, 90%, respectively. mean changed 6.9 (before dupilumab) 0.3 (after dupilumab). In addition improvement EoE, use corticosteroids inhaled asthma decreased patients, suggesting may be effective multiple concurrent conditions. had well-tolerated safety profile, except one patient who developed conjunctivitis. pediatric demonstrates effectiveness current A longitudinal, large prospective necessary guide initiation childhood long-term follow-up data on are required. Not applicable.

Язык: Английский

Процитировано

0
Efficacy of Dupilumab in the Treatment of Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials DOI Creative Commons

Szu-Hung Chu,

Jeng-Jung Chen,

Chung-Chu Chen

и другие.

Life, Год журнала: 2025, Номер 15(2), С. 307 - 307

Опубликована: Фев. 17, 2025

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus with rising prevalence. Dupilumab (DUPI), monoclonal antibody that targets interleukin-4 receptor α, has shown promise as treatment option. We conducted systematic review and network meta-analysis randomized controlled trials searching PubMed/Medline database, Cochrane Database Systematic Reviews, Central Register Controlled Trials (CENTRAL), medRxiv preprint server up to 31 July 2024, assessing DUPI's efficacy optimal dosing in EoE. Finally, three randomized-controlled comprising 470 participants, including 102 children under 12 years age, were included qualitative synthesis. Both high-exposure (HE-DUPI, 300 mg weekly) low-exposure (LE-DUPI, biweekly) regimens achieved significant histologic remission relative placebo (OR = 26.88, 95% CI 11.98-60.29 for LE-DUPI; OR 29.15, 13.68-62.12 HE-DUPI). Although overall adverse events comparable between groups, HE-DUPI was associated notable increase serious events. These findings suggest DUPI effective promoting EoE, LE-DUPI emerging preferred option balancing safety. This study highlights safety profiles different pediatric groups. Further studies are warranted explore long-term outcomes identify patient subgroups may derive greatest benefit from therapy.

Язык: Английский

Процитировано

0
Real-world Effectiveness of Dupilumab in Eosinophilic Esophagitis DOI
Archit Garg, Vishali Moond, Sugirdhana Velpari

и другие.

Journal of Clinical Gastroenterology, Год журнала: 2025, Номер unknown

Опубликована: Фев. 17, 2025

Background: Dupilumab is the only FDA-approved medication for eosinophilic esophagitis (EoE). Clinical trials have shown its effectiveness in alleviating symptoms and decreasing inflammation associated with EoE. However, real-world data on efficacy still limited. Methods: We searched multiple databases articles reporting outcomes of dupilumab treatment EoE conducted a meta-analysis. Results: Five retrospective studies including 209 subjects (mean age: 22.12±12.01 y 61.24% males) were analyzed. The pooled outcome symptom improvement was 89.2% [95% Cl: 68.0%-97.0%; I 2 =58%]. Peak eosinophil count improved markedly postdupilumab [pre: 47.13 (95% 45.5-48.67; =98%) vs. post: 6.44 0.72-13.60; eos/hpf, P <0.001]. There significant reduction Endoscopic Reference Score (EREFS) 4.10 1.74-6.43; =95%) 0.77 0.14-1.7; =95%), mean duration follow-up 5.66±1.14 months. most common adverse event reported pain due to injection, which controlled local anesthetics. Conclusion: Our study shows that scenario, administration induces histologic endoscopic remission symptomatic improvement. Hence, can be considered option EoE, especially resistant cases. Future should evaluate long-term preventing esophageal fibrosis/stricture side effect profile. Furthermore, cost-effectiveness analysis warranted help establish role as potential first-line strategy.

Язык: Английский

Процитировано

0
Essentials of Eosinophilic Esophagitis: A Guide for Primary Care DOI

Erika Banks,

Yeow Chye Ng

The Journal for Nurse Practitioners, Год журнала: 2025, Номер 21(4), С. 105343 - 105343

Опубликована: Март 7, 2025

Язык: Английский

Процитировано

0
Treatment of eosinophilic esophagitis: literature review and own clinical observations DOI
V. O. Kaybysheva, Е. Д. Федоров, Sergey Georgievich Shapovaliantc

и другие.

Russian Journal of Allergy, Год журнала: 2025, Номер unknown

Опубликована: Март 6, 2025

Aim: to systemize existing data on the treatment strategies for patients with eosinophilic esophagitis. Eosinophilic esophagitis is a T2- disease characterized by infiltration of esophageal mucosa, subepithelial and submucosal fibrosis, progressive dysphagia. Early diagnosis appropriate can prevent development strictures other complications. The includes use elimination diets, pharmacological therapy, endoscopic dilation or bougienage strictures. most effective drugs achieving clinical histological remission in are proton pump inhibitors, topical glucocorticosteroids, biological agents represented monoclonal antibodies. Over time, advantages systemic antibody therapies (anti-IL4/IL-13) over inhibitors glucocorticosteroids have become evident, particularly terms their impact mucosal inflammation remodeling wall. Currently, only approved anti-interleukin drug dupilumab, which has demonstrated high efficacy safety trials children aged 1 year older, as well adults. Endoscopic performed who stenosis (with an diameter 13 mm) following course pharmacotherapy. To this day, numerous questions remain regarding maintenance its duration, predictors progression. With emergence new biologic esophagitis, accessibility, long-term efficacy, critically important considerations.

Язык: Английский

Процитировано

0
Eosinophilic esophagitis: Current concepts of pathophysiology, diagnosis, and treatment DOI Creative Commons
Diego García‐Compeán, Alan Rafael Jiménez-Rodríguez,

C.E. González-Martínez

и другие.

Revista de Gastroenterología de México (English Edition), Год журнала: 2025, Номер unknown

Опубликована: Апрель 1, 2025

Язык: Английский

Процитировано

0
Eosinophilic Esophagitis—What Do We Know So Far? DOI Open Access

Jakub Wąsik,

Ewa Małecka‐Panas

Journal of Clinical Medicine, Год журнала: 2023, Номер 12(6), С. 2259 - 2259

Опубликована: Март 14, 2023

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

Язык: Английский

Процитировано

10