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New Therapeutic Frontiers in the Treatment of Eosinophilic Esophagitis

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Evan S. Dellon, MD, MPH

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References

  1. Rossi CM, Santacroce G, Lenti MV, di Sabatino A. Eosinophilic esophagitis in the era of biologics. Expert Rev Gastroenterol Hepatol. 2024;18(6):271-281. doi:10.1080/17474124.2024.2374471

  2. Dellon ES, Liacouras CA, Molina-Infante J, et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018;155(4):1022-1033.e10. doi:10.1053/j.gastro.2018.07.009

  3. Geow R, Arena G, Siah C, Picardo S. A retrospective real-world study on the safety and efficacy of budesonide orodispersible tablets for the induction therapy of eosinophilic oesophagitis. Therap Adv Gastroenterol. 2024;17:17562848241290346. doi:10.1177/17562848241290346

  4. Sato H, Dellon ES, Aceves SS, et al. Clinical and molecular correlates of the Index of Severity for Eosinophilic Esophagitis. J Allergy Clin Immunol. 2024;154(2):375-386.e4. doi:10.1016/j.jaci.2024.04.025

  5. Dellon ES, Khoury P, Muir AB, et al. A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. Gastroenterology. 2022;163(1):59-76. doi:10.1053/j.gastro.2022.03.025   

  6. Thel HL, Anderson C, Xue AZ, Jensen ET, Dellon ES. Prevalence and Costs of Eosinophilic Esophagitis in the United States. Clin Gastroenterol Hepatol. 2025;23(2)272-280. doi:10.1016/j.cgh.2024.09.031

  7. Yang E-J, Jung KW. Role of endoscopy in eosinophilic esophagitis. Clin Endosc. 2025;58(1):1-9. doi.org/10.5946/ce.2024.023 

  8. Chehade M, Dellon ES, Spergel JM, et al. Dupilumab for Eosinophilic Esophagitis in Patients 1 to 11 Years of Age. N Engl J Med. 2024;390(24):2239-2251. doi:10.1056/NEJMoa2312282

  9. Hirano I, Collins MH, Katzka DA, et al; ORBIT1/SHP621-301 Investigators. Budesonide Oral Suspension Improves Outcomes in Patients With Eosinophilic Esophagitis: Results from a Phase 3 Trial. Clin Gastroenterol Hepatol. 2022;20(3):525-534.e10. doi:10.1016/j.cgh.2021.04.022 

  10. Dellon ES, Katzka DA, Collins MH, et al; MP-101-06 Investigators. Budesonide Oral Suspension Improves Symptomatic, Endoscopic, and Histologic Parameters Compared With Placebo in Patients With Eosinophilic Esophagitis. Gastroenterology. 2017;152(4):776-786.e5. doi:10.1053/j.gastro.2016.11.021

  11. Dellon ES, Charriez CM, Zhang S, et al. Cendakimab efficacy and safety in adult and adolescent patients with eosinophilic esophagitis 48-week results from the randomized, placebo-controlled, phase 3 study (late-breaking abstract). Paper presented at: ACG 2024 Annual Scientific Meeting. Philadelphia, Pennsylvania. October 25-30, 2024.

  12. National Institutes of Health, National Library of Medicine, Cinicaltrials.gov website. Efficacy and Safety of Tezepelumab in Patients With Eosinophilic Esophagitis (CROSSING). ClinicalTrials.gov ID NCT05583227. Published December 2024. Accessed February 3, 2025. https://clinicaltrials.gov/study/NCT05583227 

  13. National Institutes of Health, National Library of Medicine, Cinicaltrials.gov website. A Study to Investigate the Efficacy and Safety of NSI-8226 in Adults with Eosinophilic Esophagitis. ClinicalTrials.gov ID NCT06598462. Published November 2024. Accessed February 3, 2025. https://clinicaltrials.gov/study/NCT06598462 

  14. National Institutes of Health, National Library of Medicine, Cinicaltrials.gov website. A Study of CDX-0519 in Patients With Eosinophilic Esophagitis (EvolvE). ClinicalTrials.gov ID NCT05774184. Published June 2024. Accessed February 3, 2025. https://clinicaltrials.gov/study/NCT05774184

Author and Disclosure Information

Evan S. Dellon, MD, MPH
Professor Medicine; 
Director of the Center for Esophageal Diseases and Swallowing,
Department of Medicine, Division of Gastroenterology
University of North Carolina School of Medicine
Chapel Hill, North Carolina 

Evan S. Dellon, MD, MPH, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Abbvie; Adare/Ellodi; Akesobio; Alfasigma; ALK; Allakos; Amgen; Apollo; Aqilion; Arena/Pfizer; Aslan; AstraZeneca; Avir; Biocryst; Bryn; Calypso; Celgene/Receptos/BMS; Celldex; EsoCap; Eupraxia; Dr. Falk Pharma; Ferring; GI Reviewers; GSK; Holoclara; Invea; Knightpoint; LucidDx; Morphic; Nexstone Immunology/Uniquity; Nutricia; Parexel/Calyx; Phathom; Regeneron; Revolo; Robarts/Alimentiv; Sanofi; Shire/Takeda; Target RWE; Upstream Bio Received research grant from: Adare/Ellodi; Allakos; Arena/Pfizer; AstraZeneca; Celldex; Eupraxia; Ferring; GSK; Meritage; Miraca; Nutricia; Celgene/Receptos/BMS; Regeneron; Revolo; Sanofi; Shire/Takeda Received educational grant from: Allakos; Aqilion; Holoclara; Invea

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GI and Hepatology News
Author(s)
Evan S. Dellon, MD, MPH
Author(s)
Evan S. Dellon, MD, MPH
Author and Disclosure Information

Evan S. Dellon, MD, MPH
Professor Medicine; 
Director of the Center for Esophageal Diseases and Swallowing,
Department of Medicine, Division of Gastroenterology
University of North Carolina School of Medicine
Chapel Hill, North Carolina 

Evan S. Dellon, MD, MPH, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Abbvie; Adare/Ellodi; Akesobio; Alfasigma; ALK; Allakos; Amgen; Apollo; Aqilion; Arena/Pfizer; Aslan; AstraZeneca; Avir; Biocryst; Bryn; Calypso; Celgene/Receptos/BMS; Celldex; EsoCap; Eupraxia; Dr. Falk Pharma; Ferring; GI Reviewers; GSK; Holoclara; Invea; Knightpoint; LucidDx; Morphic; Nexstone Immunology/Uniquity; Nutricia; Parexel/Calyx; Phathom; Regeneron; Revolo; Robarts/Alimentiv; Sanofi; Shire/Takeda; Target RWE; Upstream Bio Received research grant from: Adare/Ellodi; Allakos; Arena/Pfizer; AstraZeneca; Celldex; Eupraxia; Ferring; GSK; Meritage; Miraca; Nutricia; Celgene/Receptos/BMS; Regeneron; Revolo; Sanofi; Shire/Takeda Received educational grant from: Allakos; Aqilion; Holoclara; Invea

Author and Disclosure Information

Evan S. Dellon, MD, MPH
Professor Medicine; 
Director of the Center for Esophageal Diseases and Swallowing,
Department of Medicine, Division of Gastroenterology
University of North Carolina School of Medicine
Chapel Hill, North Carolina 

Evan S. Dellon, MD, MPH, has disclosed the following relevant financial relationships: Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Abbvie; Adare/Ellodi; Akesobio; Alfasigma; ALK; Allakos; Amgen; Apollo; Aqilion; Arena/Pfizer; Aslan; AstraZeneca; Avir; Biocryst; Bryn; Calypso; Celgene/Receptos/BMS; Celldex; EsoCap; Eupraxia; Dr. Falk Pharma; Ferring; GI Reviewers; GSK; Holoclara; Invea; Knightpoint; LucidDx; Morphic; Nexstone Immunology/Uniquity; Nutricia; Parexel/Calyx; Phathom; Regeneron; Revolo; Robarts/Alimentiv; Sanofi; Shire/Takeda; Target RWE; Upstream Bio Received research grant from: Adare/Ellodi; Allakos; Arena/Pfizer; AstraZeneca; Celldex; Eupraxia; Ferring; GSK; Meritage; Miraca; Nutricia; Celgene/Receptos/BMS; Regeneron; Revolo; Sanofi; Shire/Takeda Received educational grant from: Allakos; Aqilion; Holoclara; Invea

Click here to view more from Gastroenterology Data Trends 2025.

Click here to view more from Gastroenterology Data Trends 2025.

References

  1. Rossi CM, Santacroce G, Lenti MV, di Sabatino A. Eosinophilic esophagitis in the era of biologics. Expert Rev Gastroenterol Hepatol. 2024;18(6):271-281. doi:10.1080/17474124.2024.2374471

  2. Dellon ES, Liacouras CA, Molina-Infante J, et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018;155(4):1022-1033.e10. doi:10.1053/j.gastro.2018.07.009

  3. Geow R, Arena G, Siah C, Picardo S. A retrospective real-world study on the safety and efficacy of budesonide orodispersible tablets for the induction therapy of eosinophilic oesophagitis. Therap Adv Gastroenterol. 2024;17:17562848241290346. doi:10.1177/17562848241290346

  4. Sato H, Dellon ES, Aceves SS, et al. Clinical and molecular correlates of the Index of Severity for Eosinophilic Esophagitis. J Allergy Clin Immunol. 2024;154(2):375-386.e4. doi:10.1016/j.jaci.2024.04.025

  5. Dellon ES, Khoury P, Muir AB, et al. A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. Gastroenterology. 2022;163(1):59-76. doi:10.1053/j.gastro.2022.03.025   

  6. Thel HL, Anderson C, Xue AZ, Jensen ET, Dellon ES. Prevalence and Costs of Eosinophilic Esophagitis in the United States. Clin Gastroenterol Hepatol. 2025;23(2)272-280. doi:10.1016/j.cgh.2024.09.031

  7. Yang E-J, Jung KW. Role of endoscopy in eosinophilic esophagitis. Clin Endosc. 2025;58(1):1-9. doi.org/10.5946/ce.2024.023 

  8. Chehade M, Dellon ES, Spergel JM, et al. Dupilumab for Eosinophilic Esophagitis in Patients 1 to 11 Years of Age. N Engl J Med. 2024;390(24):2239-2251. doi:10.1056/NEJMoa2312282

  9. Hirano I, Collins MH, Katzka DA, et al; ORBIT1/SHP621-301 Investigators. Budesonide Oral Suspension Improves Outcomes in Patients With Eosinophilic Esophagitis: Results from a Phase 3 Trial. Clin Gastroenterol Hepatol. 2022;20(3):525-534.e10. doi:10.1016/j.cgh.2021.04.022 

  10. Dellon ES, Katzka DA, Collins MH, et al; MP-101-06 Investigators. Budesonide Oral Suspension Improves Symptomatic, Endoscopic, and Histologic Parameters Compared With Placebo in Patients With Eosinophilic Esophagitis. Gastroenterology. 2017;152(4):776-786.e5. doi:10.1053/j.gastro.2016.11.021

  11. Dellon ES, Charriez CM, Zhang S, et al. Cendakimab efficacy and safety in adult and adolescent patients with eosinophilic esophagitis 48-week results from the randomized, placebo-controlled, phase 3 study (late-breaking abstract). Paper presented at: ACG 2024 Annual Scientific Meeting. Philadelphia, Pennsylvania. October 25-30, 2024.

  12. National Institutes of Health, National Library of Medicine, Cinicaltrials.gov website. Efficacy and Safety of Tezepelumab in Patients With Eosinophilic Esophagitis (CROSSING). ClinicalTrials.gov ID NCT05583227. Published December 2024. Accessed February 3, 2025. https://clinicaltrials.gov/study/NCT05583227 

  13. National Institutes of Health, National Library of Medicine, Cinicaltrials.gov website. A Study to Investigate the Efficacy and Safety of NSI-8226 in Adults with Eosinophilic Esophagitis. ClinicalTrials.gov ID NCT06598462. Published November 2024. Accessed February 3, 2025. https://clinicaltrials.gov/study/NCT06598462 

  14. National Institutes of Health, National Library of Medicine, Cinicaltrials.gov website. A Study of CDX-0519 in Patients With Eosinophilic Esophagitis (EvolvE). ClinicalTrials.gov ID NCT05774184. Published June 2024. Accessed February 3, 2025. https://clinicaltrials.gov/study/NCT05774184

References

  1. Rossi CM, Santacroce G, Lenti MV, di Sabatino A. Eosinophilic esophagitis in the era of biologics. Expert Rev Gastroenterol Hepatol. 2024;18(6):271-281. doi:10.1080/17474124.2024.2374471

  2. Dellon ES, Liacouras CA, Molina-Infante J, et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018;155(4):1022-1033.e10. doi:10.1053/j.gastro.2018.07.009

  3. Geow R, Arena G, Siah C, Picardo S. A retrospective real-world study on the safety and efficacy of budesonide orodispersible tablets for the induction therapy of eosinophilic oesophagitis. Therap Adv Gastroenterol. 2024;17:17562848241290346. doi:10.1177/17562848241290346

  4. Sato H, Dellon ES, Aceves SS, et al. Clinical and molecular correlates of the Index of Severity for Eosinophilic Esophagitis. J Allergy Clin Immunol. 2024;154(2):375-386.e4. doi:10.1016/j.jaci.2024.04.025

  5. Dellon ES, Khoury P, Muir AB, et al. A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. Gastroenterology. 2022;163(1):59-76. doi:10.1053/j.gastro.2022.03.025   

  6. Thel HL, Anderson C, Xue AZ, Jensen ET, Dellon ES. Prevalence and Costs of Eosinophilic Esophagitis in the United States. Clin Gastroenterol Hepatol. 2025;23(2)272-280. doi:10.1016/j.cgh.2024.09.031

  7. Yang E-J, Jung KW. Role of endoscopy in eosinophilic esophagitis. Clin Endosc. 2025;58(1):1-9. doi.org/10.5946/ce.2024.023 

  8. Chehade M, Dellon ES, Spergel JM, et al. Dupilumab for Eosinophilic Esophagitis in Patients 1 to 11 Years of Age. N Engl J Med. 2024;390(24):2239-2251. doi:10.1056/NEJMoa2312282

  9. Hirano I, Collins MH, Katzka DA, et al; ORBIT1/SHP621-301 Investigators. Budesonide Oral Suspension Improves Outcomes in Patients With Eosinophilic Esophagitis: Results from a Phase 3 Trial. Clin Gastroenterol Hepatol. 2022;20(3):525-534.e10. doi:10.1016/j.cgh.2021.04.022 

  10. Dellon ES, Katzka DA, Collins MH, et al; MP-101-06 Investigators. Budesonide Oral Suspension Improves Symptomatic, Endoscopic, and Histologic Parameters Compared With Placebo in Patients With Eosinophilic Esophagitis. Gastroenterology. 2017;152(4):776-786.e5. doi:10.1053/j.gastro.2016.11.021

  11. Dellon ES, Charriez CM, Zhang S, et al. Cendakimab efficacy and safety in adult and adolescent patients with eosinophilic esophagitis 48-week results from the randomized, placebo-controlled, phase 3 study (late-breaking abstract). Paper presented at: ACG 2024 Annual Scientific Meeting. Philadelphia, Pennsylvania. October 25-30, 2024.

  12. National Institutes of Health, National Library of Medicine, Cinicaltrials.gov website. Efficacy and Safety of Tezepelumab in Patients With Eosinophilic Esophagitis (CROSSING). ClinicalTrials.gov ID NCT05583227. Published December 2024. Accessed February 3, 2025. https://clinicaltrials.gov/study/NCT05583227 

  13. National Institutes of Health, National Library of Medicine, Cinicaltrials.gov website. A Study to Investigate the Efficacy and Safety of NSI-8226 in Adults with Eosinophilic Esophagitis. ClinicalTrials.gov ID NCT06598462. Published November 2024. Accessed February 3, 2025. https://clinicaltrials.gov/study/NCT06598462 

  14. National Institutes of Health, National Library of Medicine, Cinicaltrials.gov website. A Study of CDX-0519 in Patients With Eosinophilic Esophagitis (EvolvE). ClinicalTrials.gov ID NCT05774184. Published June 2024. Accessed February 3, 2025. https://clinicaltrials.gov/study/NCT05774184

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New Therapeutic Frontiers in the Treatment of Eosinophilic Esophagitis

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New Therapeutic Frontiers in the Treatment of Eosinophilic Esophagitis

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Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by symptoms of esophageal dysfunction and dense eosinophilic infiltration. The prevalence of EoE continues to increase in the United States, with genetic, environmental, and microbiome factors contributing to its rise.1 This condition manifests as dysphagia for solid food in adults and adolescents and can lead to esophageal remodeling if untreated; symptoms are non-specific in children. Diagnosis of EoE is per International Consensus Criteria.2 Management options include proton pump inhibitors, elimination diets, topical steroids, and biologics.1

Recent advances in treatment include the US FDA approval of the swallowed topical steroid budesonide oral suspension and of a monoclonal antibody targeting interleukins (IL)-4/IL-13 (dupilumab).3 The positioning of biologics continues to evolve but, as for other atopic conditions, they are mostly used as “step-up” treatment for more difficult-to-treat patients with EoE. The Index of Severity of Eosinophilic Esophagitis (I-SEE), developed in 2022, has been shown to be a promising clinical tool for assessing and following EoE severity that may ultimately help to better manage treatment modalities.4,5 After prescribing treatment, careful assessment of symptomatic, endoscopic, and histologic outcomes is needed to determine response.3 In addition, understanding of various inflammatory mechanisms has led to the ongoing development and evaluation of new biological drugs targeting the Th2 axis and fibrosis.1,3 More studies are needed to determine the effects of these emerging therapies as well as the long-term outcomes of existing treatments for patients with EoE.

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