Emerging therapies for eosinophilic esophagitis

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.