Refractory Eosinophilic Esophagitis: What to do When the Patient has not Responded to Proton Pump Inhibitors, Steroids and Diet

Alexandra L. Strauss; Gary W. Falk


Curr Opin Gastroenterol. 2022;38(4):395-401. 

In This Article

What are Potential Treatment Modalities for the Future?

Trials of novel steroid compounds and therapies for targeting immune pathways and cytokine signalling offer considerable potential in the future for more targeted therapy of EoE. In Europe, budesonide orally dissolving tablets, formulated to optimize oesophageal delivery, are already available. Budesonide oral suspension and orally dissolving fluticasone are undergoing clinical trials but are not yet approved by the FDA.[30,43] These formulations eliminate the heterogeneity found with off-label use of corticosteroids and improve ease of administration. A variety of mAbs that target eosinophils or inflammatory signalling pathways have been developed and are under study such as Benralizumab (NCT04543409), Dupilumab (NCT03633617), Cendakimab (NCT04753697), Etrasimod (NCT04682639), IRL 201104 (NCT05084963) and Lirentelimab (NCT04322708). Notably, a phase 2 clinical trial of Cendakimab, an anti-IL13 mAb, demonstrated significant reductions in oesophageal eosinophil counts, histologic features and endoscopic features for a subgroup of enrolled patients with steroid refractory disease.[44] At this time, patients refractory to standard therapy have a variety of clinical trials to consider entering (Table 3).[6]