Effective treatment of eosinophilic disorders: A Synthesis of Findings from 19 Studies

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Original Abstract of the Article

Main research findings

Several studies have explored the development of biologics targeting eosinophils as a novel treatment approach for eosinophilic disorders. 1 discussed currently US Food and Drug Administration (FDA) approved eosinophil-specific biologics targeting IL-5 (mepolizumab and reslizumab) and IL-5R (benralizumab), along with biologics under investigation targeting siglec-8 (lirentelimab). These biologics have shown efficacy in diseases such as eosinophilic asthma, hypereosinophilic syndrome (HES), eosinophilic granulomatosis with polyangiitis (EGPA), and chronic rhinosinusitis with nasal polyposis (CRSwNP). 14 provides a detailed overview of the development of anti-IL-13 biologics for asthma treatment. However, the results of trials using these biologics for treating eosinophilic esophagitis (EoE) and eosinophilic gastrointestinal disease (EGID) have been less than ideal, as reported in 1 .

Dupilumab, a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13 signaling, has emerged as a promising new treatment for eosinophilic esophagitis (EoE). 17 explored the potential therapeutic benefits of dupilumab for EoE. Further, 10 presented the findings of a phase 3 clinical trial assessing the long-term efficacy and safety of dupilumab in adults and adolescents with EoE.

A study evaluated the efficacy and safety of benralizumab, an eosinophil-depleting monoclonal antibody, for treating eosinophilic gastritis. 11 detailed the findings of this investigation.

Treatment summary

Biologics targeting eosinophils have gained attention as a promising treatment strategy for eosinophilic disorders. 1 discussed IL-5 (mepolizumab and reslizumab) and IL-5R (benralizumab) targeting biologics that are FDA-approved, alongside biologics under investigation targeting siglec-8 (lirentelimab). These biologics have shown efficacy in diseases such as eosinophilic asthma, hypereosinophilic syndrome (HES), eosinophilic granulomatosis with polyangiitis (EGPA), and chronic rhinosinusitis with nasal polyposis (CRSwNP).

Dupilumab, a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13 signaling, has emerged as a promising new treatment for eosinophilic esophagitis (EoE). 17 explored the potential therapeutic benefits of dupilumab for EoE. Further, 10 presented the findings of a phase 3 clinical trial assessing the long-term efficacy and safety of dupilumab in adults and adolescents with EoE.

A study evaluated the efficacy and safety of benralizumab, an eosinophil-depleting monoclonal antibody, for treating eosinophilic gastritis. 11 detailed the findings of this investigation.

Benefits and risks

Benefits summary

Biologics targeting eosinophils provide a new treatment option for patients who have not responded well to conventional therapies for eosinophilic disorders. 1 highlighted the efficacy of these biologics in eosinophilic asthma, hypereosinophilic syndrome (HES), eosinophilic granulomatosis with polyangiitis (EGPA), and chronic rhinosinusitis with nasal polyposis (CRSwNP).

Dupilumab, a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13 signaling, has emerged as a promising new treatment for eosinophilic esophagitis (EoE). 17 explored the potential therapeutic benefits of dupilumab for EoE. Further, 10 presented the findings of a phase 3 clinical trial assessing the long-term efficacy and safety of dupilumab in adults and adolescents with EoE.

A study evaluated the efficacy and safety of benralizumab, an eosinophil-depleting monoclonal antibody, for treating eosinophilic gastritis. 11 detailed the findings of this investigation.

Risks summary

Biologics carry the potential risk of side effects, including an increased risk of infections. 1 discussed the safety profile of these biologics. Dupilumab may cause side effects like conjunctivitis and eyelid inflammation. 17 discussed the potential side effects associated with dupilumab.

Comparison between studies

Commonalities between studies

Multiple studies have investigated the development of biologics targeting eosinophils as a novel treatment for eosinophilic disorders. The primary goal of these studies is to assess the effectiveness and safety of these biologics.

Differences between studies

Each study focused on different eosinophilic disorders and biologics. For instance, 1 reviewed biologics targeting IL-5 and IL-5R, along with those targeting siglec-8. In contrast, 17 specifically investigated dupilumab, a blocker of IL-4 and IL-13 signaling.

Consistency and discrepancies in results

Research suggests that biologics targeting eosinophils can be effective in treating eosinophilic disorders. However, it is important to note that these biologics may not be effective for all patients. Additionally, it is crucial to consider the potential risks associated with these therapies.

Points to note regarding real-world application

Biologics targeting eosinophils offer a promising new approach for treating eosinophilic disorders. These therapies provide alternative options for patients who have not responded well to conventional treatments. However, these therapies also come with the potential for side effects. Therefore, it is essential to discuss treatment options thoroughly with a physician before making a decision.

Limitations of current research

While the development of biologics targeting eosinophils is ongoing, long-term use of these agents needs further investigation to fully understand their impact.

Future research directions

Future research should focus on evaluating the long-term efficacy and safety of biologics targeting eosinophils. Additionally, further research is needed to determine the optimal use of these agents.

Conclusion

Biologics targeting eosinophils hold significant promise as a new treatment approach for eosinophilic disorders. However, it is crucial to be aware of the potential side effects associated with these therapies. Ongoing research is expected to shed further light on their efficacy and safety.

For patients struggling with eosinophilic disorders, these novel therapies represent a potential source of hope. However, before making a treatment decision, it is essential to have a comprehensive discussion with a healthcare professional.

Treatment list

Mepolizumab, Reslizumab, Benralizumab, Lirentelimab, Dupilumab

Literature analysis of 19 papers
Positive Content
16
Neutral Content
1
Negative Content
2
Article Type
2
0
1
8
19
1.

Current and emerging biologic therapies targeting eosinophilic disorders.

Author: PitlickMitchell M, LiJames T, PongdeeThanai

Eosinophilic disorder treatment
Biologic side effects

Eosinophil-specific biologics targeting IL-5 and IL-5R have been approved for treating eosinophilic asthma, hypereosinophilic syndrome, eosinophilic granulomatosis with polyangiitis, and chronic rhinosinusitis with nasal polyposis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

2.

Eosinophilic esophagitis: Immune mechanisms and therapeutic targets.

Author: KhokharDilawar, MarellaSahiti, IdelmanGila, ChangJoy W, ChehadeMirna, HoganSimon P

EoE treatment
Esophageal inflammation

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus. It causes difficulty swallowing and food getting stuck in the esophagus. This article discusses the immune system and cells that are involved in EoE and how new treatments are being developed.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Improving Care in Eosinophil-Associated Diseases: A Charter.

Author: JacksonDavid J, AkuthotaPraveen, AndradasRebeca, BredenoordAlbert J, CordellAmanda, GraySarah, KullmanJoyce, MathurSameer K, PavordIan, RoufosseFlorence, RubioChristian, RusekIrena Clisson, SimonDagmar, StrobelMary Jo, WindersTonya

EAD diagnosis
EAD treatment

This charter outlines patient rights and expectations for managing eosinophil-associated diseases (EADs), which encompass a range of conditions where eosinophils play a significant role. It calls for improved awareness, timely diagnosis, access to multidisciplinary teams, and safe and effective treatment options to improve health outcomes for patients with EADs.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

4.

Disease Burden and Unmet Need in Eosinophilic Esophagitis.

Author: BredenoordAlbert J, PatelKiran, SchoepferAlain M, DellonEvan S, ChehadeMirna, AcevesSeema S, SpergelJonathan M, ShumelBrad, DenizYamo, RowePaul J, Jacob-NaraJuby A

Improved quality of life
Dysphagia
Food-related illness
Social and psychological implications

Eosinophilic esophagitis (EoE) is a chronic, progressive disease with increasing prevalence. This review explores the progression of EoE, highlights the patient perspective on disease burden, and discusses the unmet need for effective long-term treatments that can normalize the immune response, reduce inflammation, and prevent remodeling and fibrosis.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

Controversies in Allergy: The Potential Role of Biologics as First-Line Therapy in Eosinophilic Disorders.

Author: DellonEvan S, SimonDagmar, WechslerMichael E

Targeted treatment

This article discusses the pros and cons of using biologics as first-line therapy for eosinophilic diseases of the airways, gastrointestinal tract, and skin. It highlights emerging biologic agents and future research directions, considering the potential for early use of biologics to prevent tissue damage and disease progression.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

7.

How do interventions to improve the efficiency of acute stroke care affect prehospital times? A systematic review and narrative synthesis.

Author: McClellandGraham, HepburnSarah, FinchTracy, PriceChristopher I

Stroke care efficiency

This review aimed to identify and describe interventions designed to improve the efficiency of acute stroke care, specifically focusing on their impact on ground-based emergency medical services (EMS) call to hospital times.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

8.

Non-esophageal eosinophilic gastrointestinal diseases: a narrative review.

Author: JanssensJ, VanuytselT

Effective treatment
Improved diagnosis

This narrative review provides an overview of non-esophageal eosinophilic gastrointestinal disorders (NEEGID), including eosinophilic gastritis, eosinophilic enteritis, and eosinophilic colitis. It discusses the latest insights into pathophysiology, diagnosis, and treatment options, highlighting the potential role of biologicals like Lirentelimab for management.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

9.

Emotional Journey of Patients with Eosinophilic Esophagitis.

Author: LarssonHelen, StrobelMary J, Perez-GuagnelliEduardo

Negative impact on QoL

This study aims to determine the emotional impact of eosinophilic esophagitis (EoE) on patients at each stage of their journey.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

10.

Efficacy and safety of dupilumab up to 52 weeks in adults and adolescents with eosinophilic oesophagitis (LIBERTY EoE TREET study): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial.

Author: RothenbergMarc E, DellonEvan S, CollinsMargaret H, HiranoIkuo, ChehadeMirna, BredenoordAlbert J, LucendoAlfredo J, SpergelJonathan M, SunXian, HamiltonJennifer D, MortensenEric, LawsElizabeth, MaloneyJennifer, MannentLeda P, McCannEilish, LiuXia, GlotfeltyLila, ShabbirArsalan

Long-term efficacy
Safety

This study assesses the long-term efficacy and safety of dupilumab, an IL-4/IL-13 blocker, in adults and adolescents with eosinophilic oesophagitis, who continued in a long-term study.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

11.

Benralizumab for eosinophilic gastritis: a single-site, randomised, double-blind, placebo-controlled, phase 2 trial.

Author: KliewerKara L, Murray-PetzoldCristin, CollinsMargaret H, AboniaJuan P, BoltonScott M, DiTommasoLauren A, MartinLisa J, ZhangXue, MukkadaVincent A, PutnamPhilip E, KellnerErinn S, DevonshireAshley L, SchwartzJustin T, KunnathurVidhya A, RosenbergChen E, LylesJohn L, ShodaTetsuo, KlionAmy D, RothenbergMarc E

Improved outcomes
Eosinophilic gastritis

Eosinophilic gastritis is a condition where eosinophils accumulate in the stomach, but their role in the disease and the effect of their depletion are unclear. Benralizumab, an eosinophil-depleting antibody, may improve outcomes in eosinophilic gastritis. This study aims to evaluate the efficacy and safety of benralizumab in patients with this condition.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Clinical Trial, Phase IIA Phase II trial is a trial that further evaluates the efficacy and safety of a new drug or treatment, whose safety has been confirmed to some extent in a Phase I trial, in a small number of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., IntramuralFunding provided by the NIH for research projects within the NIH.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

12.

The international consensus classification of eosinophilic disorders and systemic mastocytosis.

Author: WangSa A, OraziAttilio, GotlibJason, ReiterAndreas, TzankovAlexandar, HasserjianRobert P, ArberDaniel A, TefferiAyalew

Improved classification
Improved diagnosis

This review focuses on the updates in the international consensus classification (ICC) for diagnosing and classifying eosinophilic disorders and systemic mastocytosis. The ICC incorporates new data and understanding of disease molecular genetics, leading to changes in diagnostic criteria and subclassification of these conditions.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

13.

Lymphomatoid papulosis associated with myeloid neoplasm with eosinophilia and FIP1L1::PDGFRA rearrangement: Successful imatinib treatment in two cases.

Author: BellaniValentina, CrociGiorgio Alberto, BucelliCristina, MaroneseCarlo Alberto, AlbertiSara, IurloAlessandra, CattaneoDaniele

Imatinib treatment
Hypereosinophilic syndromes
LyP

This case report describes two patients diagnosed with both lymphomatoid papulosis (LyP) and myeloid neoplasm with eosinophilia. Both patients achieved complete remission of both conditions after starting imatinib, suggesting a potential treatment approach for this unusual combination of diseases.

Case ReportsIn the medical field, a report that describes in detail a unique case, an unusual medical condition, or the effect of a treatment. Provides new insights and possibilities for treatment through individual patient cases.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.

Language : English

15.

Plain Language Summary of principles for improving the care of people with eosinophil-associated diseases.

Author: J JacksonDavid, AkuthotaPraveen, AndradasRebeca, J BredenoordAlbert, CordellAmanda, GraySarah, KullmanJoyce, MathurSameer K, PavordIan, RoufosseFlorence, RubioChristian, RusekIrena Clisson, SimonDagmar, StrobelMary Jo, WindersTonya

Improved diagnosis and treatment
Reduced patient burden
Delays in diagnosis and treatment
Financial barriers

Eosinophil-associated diseases (EADs) are a group of conditions characterized by the involvement of eosinophils. Patients with EADs experience significant challenges, including delays in diagnosis, financial barriers, and poor health outcomes. This charter outlines key elements of good quality care for people with EADs and presents an action plan to improve their health and well-being.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

16.

One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial.

Author: KliewerKara L, GonsalvesNirmala, DellonEvan S, KatzkaDavid A, AboniaJuan P, AcevesSeema S, ArvaNicoleta C, BesseJohn A, BonisPeter A, CaldwellJulie M, CapocelliKelley E, ChehadeMirna, CianferoniAntonella, CollinsMargaret H, FalkGary W, GuptaSandeep K, HiranoIkuo, KrischerJeffrey P, LeungJohn, MartinLisa J, Menard-KatcherPaul, MukkadaVincent A, PetersonKathryn A, ShodaTetsuo, Rudman SpergelAmanda K, SpergelJonathan M, YangGuang-Yu, ZhangXue, FurutaGlenn T, RothenbergMarc E

Eosinophilic oesophagitis treatment

Eosinophilic oesophagitis is a condition where the oesophagus becomes inflamed. This study compares a six-food elimination diet with a one-food elimination diet in adults with eosinophilic oesophagitis, aiming to determine the more effective dietary approach.

Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

17.

Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis.

Author: DellonEvan S, RothenbergMarc E, CollinsMargaret H, HiranoIkuo, ChehadeMirna, BredenoordAlbert J, LucendoAlfredo J, SpergelJonathan M, AcevesSeema, SunXian, KosloskiMatthew P, KamalMohamed A, HamiltonJennifer D, BeazleyBethany, McCannEilish, PatelKiran, MannentLeda P, LawsElizabeth, AkinladeBolanle, AminNikhil, LimWei Keat, WippermanMatthew F, RuddyMarcella, PatelNaimish, WeinreichDavid R, YancopoulosGeorge D, ShumelBrad, MaloneyJennifer, GiannelouAngeliki, ShabbirArsalan

Histologic remission
Symptom alleviation
Serious adverse events

Subcutaneous dupilumab administered weekly to patients with eosinophilic esophagitis significantly improved histological outcomes and alleviated symptoms. Histologic remission occurred in 60% of patients receiving weekly dupilumab compared to 5% of those receiving placebo.

Clinical Trial, Phase IIIA Phase III trial is a trial that further rigorously verifies the efficacy and safety of a new drug or treatment, whose efficacy and safety have been confirmed in a Phase II trial, in a large number of patients, and evaluates whether it is superior to existing treatments.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

18.

Clinical guidance for the use of dupilumab in eosinophilic esophagitis: A yardstick.

Author: AcevesSeema S, DellonEvan S, GreenhawtMatthew, HiranoIkuo, LiacourasChris A, SpergelJonathan M

EoE treatment

This expert opinion document provides a framework for how clinicians can consider using dupilumab, the first medication approved for the treatment of eosinophilic esophagitis (EoE), in the treatment strategy for patients with EoE.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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