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Clinical Reviews in Allergy & Immunology

, Volume 55, Issue 1, pp 88–98 | Cite as

Monoclonal Antibodies for Treatment of Eosinophilic Esophagitis

  • Mahsa Eskian
  • MirHojjat Khorasanizadeh
  • Amal H. Assa’ad
  • Nima Rezaei
Article

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.

Keywords

Eosinophilic esophagitis Biological therapy Monoclonal antibody Mepolizumab Omalizumab Reslizumab IL-5 

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

Notes

Compliance with Ethical Standards

No human or animals participants were included in this study.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Molecular Immunology Research Center, Children’s Medical CenterTehran University of Medical SciencesTehranIran
  2. 2.Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN)TehranIran
  3. 3.Division of Allergy and ImmunologyCincinnati Children’s Medical CenterCincinnatiUSA
  4. 4.Research Center for Immunodeficiencies, Children’s Medical CenterTehran University of Medical SciencesTehranIran
  5. 5.Department of Immunology, School of MedicineTehran University of Medical SciencesTehranIran
  6. 6.Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN)BostonUSA

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