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TOPLINE:

Dupilumab 300 mg, cendakimab 360 mg, and budesonide oral suspension 2 mg demonstrated a moderate-to-high level of effectiveness in improving dysphagia in adolescents and adults with eosinophilic esophagitis (EoE). Most tested therapies, except for etrasimod, resulted in histologic remission.

METHODOLOGY:

• EoE is a major cause of dysphagia, food impaction, and decreased quality of life, and current treatment approaches focus on reducing esophageal inflammation and preventing long-term complications, with three pharmacologic agents approved to date — dupilumab and two oral formulations of budesonide.
• Researchers conducted a systematic review and network meta-analysis of randomized controlled trials comparing corticosteroids, biologics, or proton pump inhibitors (PPI) with placebo or active comparators in participants aged 12 years or older with EoE, with a minimum follow-up duration of 12 weeks.
• A total of 13 trials enrolling 2163 adolescents and adults with EoE were included, evaluating interventions such as dupilumab 300 mg, benralizumab 30 mg, mepolizumab 300 mg, cendakimab 360 mg, lirentelimab (1 mg/kg and 3 mg/kg), etrasimod (1 mg and 2 mg), budesonide oral suspension 2 mg, APT-1011 (various doses), budesonide orodispersible tablets (0.5 mg and 1 mg), and placebo.
• Key outcomes were the changes in dysphagia from baseline and histologic remission (six or fewer eosinophils per high-power field) at 12, 24, and 48 weeks; treatments were ranked using the surface under the cumulative ranking curve (SUCRA).
• Additional outcomes assessed included endoscopic improvement measured using changes in the EoE Endoscopic Reference Score at 12, 24, and 48 weeks, EoE Histologic Scoring System grade and stage (0-3) at 24 weeks, absolute change in peak eosinophil count at 12 weeks, and histologic response (< 15 eosinophils per high-power field) at all timepoints.

TAKEAWAY:

• At 12 weeks and 24 weeks, dupilumab 300 mg demonstrated high-certainty improvement in dysphagia compared with placebo, and cendakimab 360 mg showed moderate-certainty benefit; budesonide oral suspension 2 mg demonstrated moderate-certainty benefit at 12 weeks. Based on SUCRA, dupilumab 300 mg ranked highest in symptomatic efficacy at 12 weeks (92%) and 24 weeks (97%).
• For histologic remission, all agents except etrasimod showed moderate-certainty benefits compared with placebo at 24 weeks. The most effective interventions identified by SUCRA ranking were budesonide oral suspension 2 mg at 12 weeks (78%) and benralizumab 30 mg at 24 weeks (80%).
• Dupilumab 300 mg and APT-1011 (3 mg at bedtime and 1.5 mg twice daily) provided high-certainty evidence of benefit for endoscopic improvement at 12 weeks, and budesonide oral suspension 2 mg and APT-1011 (1.5 mg at bedtime and 3 mg twice daily) provided moderate-certainty benefit compared with placebo.
• At 24 weeks, dupilumab 300 mg and cendakimab 360 mg demonstrated high-certainty evidence of benefit for endoscopic improvement compared with placebo, whereas etrasimod 2 mg showed moderate-certainty benefit compared with placebo. Dupilumab 300 mg, cendakimab 360 mg, and etrasimod (1 mg and 2 mg) displayed high-certainty benefits over placebo for both grade and stage scores of the EoE Histologic Scoring System at 24 weeks.

IN PRACTICE:

“[T]he symptom and endoscopic outcomes highlight dupilumab 300 mg, cendakimab 360 mg, and BOS [budesonide oral suspension] 2 mg as valuable therapeutic options with moderate certainty of benefit for the management of EoE within a 12-week timeframe. All three were also effective in achieving histologic remission and response, while dupilumab 300 mg showed superior results in other secondary histologic outcomes, including EoE-HSS [EoE Histologic Scoring System] and changes in peak eosinophil count,” the authors of the study wrote.

SOURCE:

The study was led by Mohammad Al Hayek, MD, Damascus University, Damascus, Syrian Arab Republic. It was published online in Clinical Gastroenterology and Hepatology.

LIMITATIONS:

Six of the included trials were phase 2 studies with small sample sizes, ranging from 19 to 41 participants. Most trials evaluating PPIs and swallowed topical corticosteroids, including budesonide and fluticasone, had follow-up durations of only 6 to 8 weeks and were excluded to reduce heterogeneity, which may limit the applicability of the findings. Safety data, especially concerning the comparative safety profiles of biologic and corticosteroid therapies, were reported insufficiently across the trials.

DISCLOSURES:

No specific funding was received for the study. Five authors disclosed receiving grants or contracts, consulting fees, payments, or honoraria from several companies, including AbbVie, AstraZeneca, Medtronic, and others.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.