Therapie der eosinophilen Ösophagitis – Fortschritte und Perspektiven

Zusammenfassung In jüngster Zeit wurden in der Therapie der eosinophilen Ösophagitis (EoE) und insbesondere im Bereich der topischen Corticosteroide erhebliche Fortschritte erreicht. Neue EoE-spezifische Darreichungsformen wurden entwickelt und haben in Form der orodispersiblen Budesonid-Tablette zu der ersten in Deutschland und anderen europäischen und außereuropäischen Ländern zugelassenen Therapie der EoE bei Erwachsenen geführt. In den USA steht eine EoE-spezifische orale Budesonid-Suspension kurz vor der Zulassung. Dagegen bleibt die wissenschaftliche Datenlage zur Wirksamkeit von Protonenpumpeninhibtoren weiterhin limitiert. Auch im Bereich der Biologika konnten nach langer Zeit Substanzen identifiziert werden, die erstmals in Phase 2 sehr vielversprechende Ergebnisse gezeigt haben und sich derzeit in klinischen Prüfungen der Phase 3 befinden. In diesem Artikel sollen die aktuellen Fortschritte und Perspektiven in der Therapie der EoE dargestellt und diskutiert werden.

[1]  E. Laserna-Mendieta,et al.  Letter: PPI in EoE – more questions than answers. Authors' reply , 2021, Alimentary Pharmacology and Therapeutics.

[2]  W. Harmsen,et al.  Proton Pump Inhibitor Therapy in Eosinophilic Esophagitis: Predictors of Nonresponse , 2020, Digestive Diseases and Sciences.

[3]  C. Schlag,et al.  Treatment of eosinophlic esophagitis with swallowed topical corticosteroids , 2020, World journal of gastroenterology.

[4]  A. Schoepfer,et al.  Wirksamkeit und Sicherheit der Langzeittherapie der Eosinophilen Ösophagitis mit einer neuen sich im Mund auflösenden Fluticason-Tablette (APT-1011): Ergebnisse einer internationalen randomisierten doppel-blinden Placebo-kontrollierten Phase 2b-Studie , 2020, Zeitschrift für Gastroenterologie - German Journal of Gastroenterology.

[5]  M. Vieth,et al.  Budesonide Orodispersible Tablets Maintain Remission in a Randomized, Placebo-Controlled Trial of Patients With Eosinophilic Esophagitis. , 2020, Gastroenterology.

[6]  E. Savarino,et al.  Efficacy of proton pump inhibitor therapy for eosinophilic oesophagitis in 630 patients: results from the EoE connect registry , 2020, Alimentary pharmacology & therapeutics.

[7]  H. Becher,et al.  Histologic and Clinical Effects of Different Topical Corticosteroids for Eosinophilic Esophagitis: Lessons from an Updated Meta-Analysis of Placebo-Controlled Randomized Trials , 2020, Digestion.

[8]  A. Straumann,et al.  Orodispersible budesonide tablets for the treatment of eosinophilic esophagitis: a review of the latest evidence , 2020, Therapeutic advances in gastroenterology.

[9]  P. Malfertheiner,et al.  A Network Meta-Analysis of Randomized Controlled Trials on the Treatment of Eosinophilic Esophagitis in Adults and Children , 2020, Journal of clinical gastroenterology.

[10]  Kenneth K Wang,et al.  AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of Eosinophilic Esophagitis. , 2020, Gastroenterology.

[11]  A. Schoepfer,et al.  Long-term Efficacy and Tolerability of RPC4046 in an Open-Label Extension Trial of Patients With Eosinophilic Esophagitis. , 2020, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[12]  A. Schoepfer,et al.  Randomised clinical trial: the safety and tolerability of fluticasone propionate orally disintegrating tablets versus placebo for eosinophilic oesophagitis , 2020, Alimentary pharmacology & therapeutics.

[13]  A. Straumann,et al.  Medical algorithm: Diagnosis and treatment of eosinophilic esophagitis in adults , 2019, Allergy.

[14]  E. Dellon,et al.  EMERGING THERAPIES FOR EOSINOPHILIC ESOPHAGITIS. , 2019, The Journal of allergy and clinical immunology.

[15]  G. Yancopoulos,et al.  Efficacy of Dupilumab in a Phase 2 Randomized Trial of Adults With Active Eosinophilic Esophagitis. , 2019, Gastroenterology.

[16]  E. Dellon,et al.  350 Efficacy of Budesonide Oral Suspension for Eosinophilic Esophagitis in Adolescents and Adults: Results From a Phase 3, Randomized, Placebo-Controlled Trial , 2019, American Journal of Gastroenterology.

[17]  E. Dellon,et al.  A Conceptual Approach to Understanding Treatment Response in Eosinophilic Esophagitis. , 2019, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[18]  A. Bredenoord,et al.  Pharmacotherapies for the Treatment of Eosinophilic Esophagitis: State of the Art Review , 2019, Drugs.

[19]  F. Lammert,et al.  Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial. , 2019, Gastroenterology.

[20]  T. Frieling,et al.  Clinical management of eosinophilic esophagitis – a nationwide survey among gastroenterologists in Germany , 2019, Zeitschrift für Gastroenterologie.

[21]  M. Vieth,et al.  Mo1129 – Efficacy of Budesonide Orodispersible Tablets for Induction of Remission in Patients with Active Eosinophilic Esophagitis: Results from the 6-Weeks Open-Label Treatment Phase of Eos-2 Trial , 2019, Gastroenterology.

[22]  E. Laserna-Mendieta,et al.  Systematic review with meta‐analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population‐based studies , 2019, Alimentary pharmacology & therapeutics.

[23]  M. Fay,et al.  Benralizumab for PDGFRA‐Negative Hypereosinophilic Syndrome , 2019, The New England journal of medicine.

[24]  E. Dellon,et al.  Safety and Efficacy of Budesonide Oral Suspension Maintenance Therapy in Patients With Eosinophilic Esophagitis , 2019, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[25]  G. Opiteck,et al.  RPC4046, a Monoclonal Antibody Against IL13, Reduces Histologic and Endoscopic Activity in Patients With Eosinophilic Esophagitis. , 2019, Gastroenterology.

[26]  J. Larson,et al.  Food impaction: etiology over 35 years and association with eosinophilic esophagitis. , 2018, Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus.

[27]  D. Katzka,et al.  Measurement of Observed Eating Behaviors in Patients With Active and Inactive Eosinophilic Esophagitis. , 2019, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[28]  A. Lucendo,et al.  Dietary therapy for eosinophilic esophagitis. , 2018, The Journal of allergy and clinical immunology.

[29]  I. Dávila,et al.  Dupilumab: A New Paradigm for the Treatment of Allergic Diseases. , 2018, Journal of investigational allergology & clinical immunology.

[30]  A. Bredenoord,et al.  The Natural Course of Eosinophilic Esophagitis and Long‐Term Consequences of Undiagnosed Disease in a Large Cohort , 2018, The American Journal of Gastroenterology.

[31]  N. Shaheen,et al.  Natural history of eosinophilic esophagitis: a systematic review of epidemiology and disease course , 2018, Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus.

[32]  E. Savarino,et al.  Step‐up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2‐4‐6 study , 2017, The Journal of allergy and clinical immunology.

[33]  E. Dellon,et al.  Epidemiology and Natural History of Eosinophilic Esophagitis. , 2017, Gastroenterology.

[34]  E. Dellon,et al.  Pathophysiology of Eosinophilic Esophagitis. , 2017, Gastroenterology.

[35]  M. Storr,et al.  [Eosinophilic Esophagitis Update: New Guidelines of the European Study Group EUREOS]. , 2018, Zeitschrift für Gastroenterologie - German Journal of Gastroenterology.

[36]  N. Shaheen,et al.  Food elimination diets are effective for long‐term treatment of adults with eosinophilic oesophagitis , 2017, Alimentary pharmacology & therapeutics.

[37]  E. Dellon,et al.  Esophageal dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis. , 2017, Gastrointestinal endoscopy.

[38]  A. Lucendo,et al.  Systematic review with meta‐analysis: endoscopic dilation is highly effective and safe in children and adults with eosinophilic oesophagitis , 2017, Alimentary pharmacology & therapeutics.

[39]  M. Vaezi,et al.  Complications of Proton Pump Inhibitor Therapy. , 2017, Gastroenterology.

[40]  L. Arias-González,et al.  Systematic review: health‐related quality of life in children and adults with eosinophilic oesophagitis—instruments for measurement and determinant factors , 2017, Alimentary pharmacology & therapeutics.

[41]  E. Dellon,et al.  Budesonide Oral Suspension Improves Symptomatic, Endoscopic, and Histologic Parameters Compared With Placebo in Patients With Eosinophilic Esophagitis. , 2017, Gastroenterology.

[42]  A. Bredenoord,et al.  Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults , 2017, United European gastroenterology journal.

[43]  H. Daniell.  Acid suppressing therapy as a risk factor for Candida esophagitis. , 2016, Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus.

[44]  J. Molina-Infante,et al.  The efficacy of step‐down therapy in adult patients with proton pump inhibitor‐responsive oesophageal eosinophilia , 2016, Alimentary pharmacology & therapeutics.

[45]  A. Lucendo,et al.  Efficacy of Proton Pump Inhibitor Drugs for Inducing Clinical and Histologic Remission in Patients With Symptomatic Esophageal Eosinophilia: A Systematic Review and Meta-Analysis. , 2016, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[46]  A. Lembo,et al.  The clinical predictors of aetiology and complications among 173 patients presenting to the Emergency Department with oesophageal food bolus impaction from 2004–2014 , 2015, Alimentary pharmacology & therapeutics.

[47]  M. Vieth,et al.  A randomised, double-blind trial comparing budesonide formulations and dosages for short-term treatment of eosinophilic oesophagitis , 2015, Gut.

[48]  Sandeep K. Gupta,et al.  Efficacy and safety of oral budesonide suspension in pediatric patients with eosinophilic esophagitis. , 2015, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[49]  A. Lucendo,et al.  Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. , 2014, Gastroenterology.

[50]  A. Schoepfer,et al.  Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. , 2013, Gastroenterology.

[51]  A. Straumann,et al.  Anti‐eosinophil activity and clinical efficacy of the CRTH2 antagonist OC000459 in eosinophilic esophagitis , 2013, Allergy.

[52]  I. Hirano,et al.  Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. , 2012, Gastroenterology.

[53]  A. Lucendo,et al.  Montelukast Was Inefficient in Maintaining Steroid-Induced Remission in Adult Eosinophilic Esophagitis , 2011, Digestive Diseases and Sciences.

[54]  J. Croffie,et al.  Comparison of oral prednisone and topical fluticasone in the treatment of eosinophilic esophagitis: a randomized trial in children. , 2008, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[55]  J. Teitelbaum.  Natural history of primary eosinophilic esophagitis: a follow up of 30 adult patients for up to 11.5 years. , 2004, Journal of pediatric gastroenterology and nutrition.

[56]  C. Beglinger,et al.  Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. , 2003, Gastroenterology.