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Monoclonal Antibodies for Treatment of Eosinophilic Esophagitis

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Abstract

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus affecting both children and adults, with debilitating and progressive symptoms. EoE has shown an explosive epidemiological rise in the past few decades. Many patients experience a poor level of disease control despite maximal use of available guideline-based therapies, which seriously hampers their quality of life. Diet restrictions and systemic and topical corticosteroids are the current mainstays of EoE therapy, but are associated with significant efficacy, treatment compliance, and safety issues such as oral or esophageal candidiasis, growth retardation, osteopenia, osteoporosis, glucose intolerance, and cataract formation. As EoE is a chronic inflammatory disease, immune cells and cytokines are responsible for the inflammatory response and symptoms. Monoclonal antibodies specifically targeting these pathophysiologic effectors offer more potent relief of histologic and clinical disease features while keeping off-target adverse effects to a minimum. Herein, we have reviewed the current evidence regarding efficacy and safety of monoclonal antibodies including mepolizumab (anti-IL-5), reslizumab (anti-IL-5), QAX576 (anti-IL-13), omalizumab (anti-immunoglobulin-E), and infliximab (anti-TNF-α) in treatment of EoE. Our review indicates that although the use of monoclonal antibodies for EoE treatment is safe with limited and reversible adverse events, however, it is not yet possible to reach a final verdict on the efficacy of mAbs in EoE. Future well-designed studies are needed to clarify the exact role of mAbs in EoE.

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Abbreviations

EoE:

Eosinophilic esophagitis

IL:

Interleukin

US:

United States

Th1/2:

T helper type 1/2

TGF:

Transforming growth factor

FGF:

Fibroblast growth factor

mg:

Milligrams

kg:

Kilograms

hpf:

High-power field

CCR3:

c-c chemokine receptor type 3

FIP1L1:

Factor interacting with PAPOLA and CPSF1

PDGFRA:

Platelet-derived growth factor receptor alpha

FDA:

Food and Drug Administration

CI:

Confidence interval

MDQ:

Mayo Dysphagia Questionnaire

CXCL:

Chemokine (C-X-C motif) ligand

DHRS9:

Dehydrogenase/reductase SDR family member 9

CPA3:

Carboxypeptidase A3

Ig:

Immunoglobulin

EGID:

Eosinophil-associated gastrointestinal disorder

TNF:

Tumor necrosis factor

IFN:

Interferon

mAb:

Monoclonal antibody

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Authors and Affiliations

  1. Molecular Immunology Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran

    Mahsa Eskian & MirHojjat Khorasanizadeh

  2. Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran

    Mahsa Eskian & MirHojjat Khorasanizadeh

  3. Division of Allergy and Immunology, Cincinnati Children’s Medical Center, Cincinnati, OH, USA

    Amal H. Assa’ad

  4. Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Sciences, Dr. Qarib St, Keshavarz Blvd, Tehran, 14194, Iran

    Nima Rezaei

  5. Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Nima Rezaei

  6. Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Boston, MA, USA

    Nima Rezaei

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  1. Mahsa Eskian
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  2. MirHojjat Khorasanizadeh
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  3. Amal H. Assa’ad
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  4. Nima Rezaei
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Correspondence to Nima Rezaei.

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Eskian, M., Khorasanizadeh, M., Assa’ad, A.H. et al. Monoclonal Antibodies for Treatment of Eosinophilic Esophagitis. Clinic Rev Allerg Immunol 55, 88–98 (2018). https://doi.org/10.1007/s12016-017-8659-7

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