Introduction
Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder from the atopic disease spectre. Despite being studied for years, the EoE-specific therapy has been approved only recently and includes budesonide orodispersible tablet (1) and IL-4R antagonist, dupilumab (2). Therefore, data on the management of the patients who do not respond to this treatment is scarce. Especially those who were diagnosed long in the past and have undergone different therapeutical approaches remain an understudied group. The aim of this project was to provide information on the treatment courses in a real-world setting over past 10 years.
Aims & Methods
This was a retrospective nation-wide project collecting data on patients with EoE in 7 Austrian centres since January 2014. The last follow-up was marked as of February 2025. Information on patients’ demographics, previous medical history, number of esophageal food impactions and different treatment lines were recorded. Due to the descriptive character of the work, no power analysis was carried out.
Results
In total, 336 patients (30.1% female) were included. Approximately one third of them (119/336) experienced an esophageal food impaction before the diagnosis was made. The most common 1st line therapy was budesonide orodispersible tablet (193/336, 57.4%), followed by proton pump inhibitors (87/336, 25.9%) and food elimination diet (20/336, 6.0%). Two hundred twenty (220/336, 65.5%) patients did not remain on the 1st line treatment. Forty-four (44/336, 13.1%) subjects required more than 2 therapies and one person received even 7th line medication. Biologic treatment – dupilumab – was given to forty-one (12.2%) patients. It was the first line treatment in 1 person, the others received it in the further course. These drugs were well-tolerated and 97.6% (40/41) patients remained on it until the last follow-up and reached symptomatic remission. Three patients were diagnosed more than 10 years before they received biologic treatment and 2 of them responded to it. One person discontinued due to side effects. The most common reasons for switch for dupilumab were clinical and/or histological activity (24/41, 58.5%), side effects (10/41, 24.4%) and patients’ preference (2/41, 4.9%).
Conclusion
This is the first study on different therapy courses in patients with EoE in Europe. Due to its retrospective character, no direct conclusions on the superiority of one approach upon another in case of refractoriness are possible.
References
1. Lucendo AJ, Miehlke S, Schlag C, Vieth M, von Arnim U, Molina-Infante J, et al. Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial. Gastroenterology. 2019;157(1):74-86.e15.
2. Hirano I, Dellon ES, Hamilton JD, Collins MH, Peterson K, Chehade M, et al. Efficacy of Dupilumab in a Phase 2 Randomized Trial of Adults With Active Eosinophilic Esophagitis. Gastroenterology. 2020;158(1):111-22.e10.
Disclosure
JP: travel grants from Johnson&Johnson and Tillots Pharma AG
MW: no conflicts of interest
PD: consulting and speakers fees from Falk Pharma, Sanofi, Abbvie, MSD, Takeda, Janssen, Pfizer
KS: support from: Abbvie, Astro Pharma, Takeda, Johnson&Johnson, MSD, Falk Pharma, Galapagos
TH: speaker fee from Falk
MH: no conflicts of interest
LKS: •Past/present Principal investigator für Studien gesponsort durch: SigmaTau, Sanofi , Tigenix und Falk;
•Speaker fee: MSD, AbbVie, Ferring, MerckSerono/Dr Falk, Chiesi, Novartis, Roche, Abbott, Phadia Austria/Thermo Fisher Scientific, CSL-Behring , Janssen-Cilag Pharma, Labors.at GmbH, Vertex, ENML Laborbetriebs GmbH, Johnson&Johnson
•Conference support: Mylan, Abbott, MSD, Gilead, MerckSerono/Dr Falk, Novartis, Pfizer, Janssen-Cilag Pharma, Chiesi, Shire, Abbvie, Takeda, Vertex, Astropharma
•Consultancy for: MSD, Takeda
GN: lecturing fees, consulting fees, and advisory fees from AbbVie, Merck Sharp & Dohme, Takeda, Janssen-Cilag, Pfizer, Gilead, Galapagos, Ferring, Vifor, AstroPharma, Falk, Bristol Myers Squibb, Arena Pharmaceuticals and Amgen
MT: received grant support from Albireo, Alnylam, Cymabay, Falk, Genentech, Gilead, Intercept, MSD, Takeda and UltraGenyx, honoraria for consulting from AbbVie, Albireo, Agomab, Boehringer Ingelheim, BiomX, Chemomab, Dexoligo Therapeutics, Falk, Genfit, Gilead, GSK, Hightide, Intercept, Ipsen, Jannsen, MSD, Novartis, Phenex, Pliant, Regulus, Siemens and Shire, speaker fees from Albireo, Boehringer Ingelheim, Bristol-Myers Squibb, Falk, Gilead, Intercept, Ipsen, Madrigal, Mirum and MSD , as well as travel support from AbbVie, Falk, Gilead, Jannsen and Intercept. He is also co-inventor of patents on the medical use of 24-norursodeoxycholic acid filed by the Medical University of Graz (service inventions).
WS: no conflicts of interest
HS: consulting and speakers fees from Falk Pharma, Sanofi, Medtronic
PS: consulting fees and/or speaker fees from Dr. Falk Pharma, GmbH, Takeda, Regerenon-Sanofi Pharmaceuticals, AbbVie, Janssen-Cilag, Receptos-Celgene-BMS
