Table 3. Summary of biologic agents studied as potential EoE treatment.
| Target | Biologics | Age group | Brief results | Ref No. |
|---|---|---|---|---|
| IL-5 | Mepolizumab | Adult | 4 patients reduced tissue eos (but all >20 eos/hpf and improved quality of life pre- vs. post-treatment | (58) |
| Adult | 5 patients reduced tissue eos (but all >30 eos/hpf) and blood eosinophils vs. placebo | (59) | ||
| No improvement in pathology and symptoms vs. placebo | ||||
| Pediatric | Reduced tissue and blood eosinophils pre- vs. post-treatment | (60) | ||
| No improvement in symptoms pre- vs. post-treatment | ||||
| Reslizumab | Pediatric | Reduced tissue eosinophils vs. placebo | (61) | |
| No improvement in symptoms vs. placebo | ||||
| Pediatric | Reduced tissue eosinophils and improved symptoms vs. placebo | (62) | ||
| IgE | Omalizumab | Pediatric | One-case report. No persistent improvement in neither symptoms nor pathology during the treatment | (63) |
| Pediatric | Two-case report | (64) | ||
| Improved clinical symptoms pre- vs. post-treatment | ||||
| No change in endoscopy and histology findings pre- vs. post-treatment | ||||
| Both | Reduced tissue eosinophils and improved symptoms pre- vs. post-treatment | (65) | ||
| No difference in blood eosinophils pre- vs. post-treatment | ||||
| Both | No improvement in tissue eosinophils and symptoms vs. placebo | (23) | ||
| IL-13 | QAX576 | Adult | Reduced tissue eosinophils vs. placebo | (66) |
| No difference in dysphagia vs. placebo | ||||
| RPC4046 | Adult | Reduced disease activity grossly (EREFS), histologically (EoEHSS) but not dysphagia vs. placebo | (67,68) | |
| IL-13 & IL-4 | Dupilumab | Adult | Reduced disease endoscopically (EREFS), histologically (EoEHSS) and clinically (SDI-PRO score) vs. placebo | (69) |
| TNF-α | Infliximab | Adult | Three-case report | (70) |
| No improvement in pathology, and heterogeneous clinical response pre- and post-treatment |
This table lists 14 publications evaluating the efficacy of 8 biologic agents. Several anti-IL5 studies showed improved histology but only one demonstrated histologic remission and clinical improvement. Three recent studies on IL13 directed therapy have shown improved eosinophilia but only dupilumab was also able to decrease symptoms. The remaining 9 studies failed to show meaningful therapeutic responses. EoE, eosinophilic esophagitis; IL, interleukin; eos, eosinophils; hpf, high power field; IgE, immunoglobulin E; EREFS, EoE endoscopic reference score; EoEHSS, eosinophilic esophagitis histologic scoring system; SDI-PRO, Straumann dysphagia instrument-patient reported outcome score; TNF-α, tumor necrosis factor alpha.