Dupixent for EoE (eosinophilic esophagitis) was recently approved by the FDA. This will be the first drug officially approved for EoE.
Eosinophilic Esophagitis is a chronic inflammatory immune disorder of the esophagus where eosinophils (a type of white blood cell) builds up in the esophagus. This can cause symptoms of difficulty swallowing, eating or food getting stuck in the esophagus. Besides the clinical symptoms, EoE is diagnosed during an endoscopy and on microscopic examination, there are more than 15 eosinophils/hpf on esophageal biopsy.
Until now, the treatment for EoE has been off label use of certain medications and avoidance of certain foods that may trigger EoE.
Dupixent is a medication that inhibits a part of the immune pathway (IL-4 and IL-13) that trigger allergic inflammation. This is the 4th allergic indication for Dupixent. Dupixent is also currently approved for Atopic Dermatitis (eczema), Nasal Polyps, and Asthma.
The dosing of Dupixent for EoE will be different than all the other indications. Dupixent will be dosed 300mg every week, without any loading dose. This is different than the 3 other indications:
Dupixent for Eczema: 600mg loading dose then 300mg every other week
Dupixent for Nasal Polys: No loading dose, 300mg every other week
Dupixent for Asthma: 600mg loading dose, then 300mg every other week
Dupixent for EoE: No loading dose, 300mg every week
*The above dosing is for adults only, Dupixent for EoE dosing is for ages 12 and up, weighing at least 88 pounds. There is a pediatric dosing indication for Dupixent using a 200mg syringe starting at age 6 years old but it is not for EoE as of May 2022. Studies are ongoing for a pediatric indication for EoE.
There are several other drugs seeking FDA approval for EoE as discussed below.
If you currently suffer from EoE or suspect you may have EoE, it is important that your care is coordinated with a GI (gastroenterologist) and an allergy doctor who can best manage your symptoms and come up with a good treatment plan that is right for you.
Update January 22, 2023
Current active clinical phase 3 trials for EoE for biologics include:
- Dupixent for the ages of 1-11.
- Benralizumab (Fasenra)
- Cendakimab targets anti-IL 13. Early studies have been encouraging meeting their primary endpoints, clinically and histologically. Studies are ongoing. This drug currently has no approved indications
- Lirentelimab is an antibody against the Siglec-8 receptor found on eosinophils and mast cells. This drug currently has no approved indications
The US FDA has granted Orphan Drug Designation to benralizumab for the treatment of EoE and a phase 3 clinical study is on-going.