The use of anti-IL-5 in eosinophilic gastrointestinal disorders (EGIDs); a systematic review

Eosinophilic gastrointestinal disorders (EGIDs), including eosinophilic esophagitis (EoE), are a chronic, immune-mediated conditions characterized by eosinophilic infiltration of the gastrointestinal tract. Current treatments have limitations in either efficacy or tolerability. Anti-interleukin-5 (IL-5) therapies, as mepolizumab, reslizumab, and benralizumab, have emerged as potential treatment options. This systematic review aimed to assess the efficacy and safety of these therapies in the treatment of EGIDs.

A systematic review of six major electronic databases, identified 1437 records. After removing duplicates and screening for relevance, six RCTs published between 2009 and 2023 met the inclusion criteria. These studies evaluated the efficacy and safety of anti-IL-5 therapies in patients with (EGIDs). Data on histologic outcomes, clinical symptoms, endoscopic findings, and adverse events were extracted. Only RCTs focusing on IL-5 inhibitors were included, while combination therapies or non-interventional studies were excluded. Risk of bias was assessed using Cochrane ROB 2 tool, and results were narratively synthesized due to study heterogeneity.

Patient ages ranged from 10 to 38 years, with a slight male predominance. Asthma and allergies were common comorbidities. Histologic outcomes showed significant reductions in peak esophageal eosinophil counts in treatment groups, particularly with mepolizumab and reslizumab (p < 0.001), and complete eosinophil depletion with benralizumab. All studies reported clinical symptom improvements, five studies also showed endoscopic improvements including lower EREFS scores and mucosal healing. Adverse events were mild and infrequent, with all therapies demonstrating good overall tolerability.

The study highlights the delay in diagnosis due to non-specific symptoms. While systemic corticosteroids remain the cornerstone of treatment, emerging biologics and non-invasive biomarkers offer promise. Early clinical suspicion, comprehensive endoscopic evaluation with biopsies, and standardized diagnostic criteria are essential for improving patient outcomes.

The review is limited by small sample sizes, short follow-up periods, varied outcome measures, and moderate to high risk of bias in some studies. These issues emphasize the need for larger, long-term RCTs with standardized outcome metrics to better assess clinical benefit.