Farmacoriflessioni
Il dupilumab nell’esofagite eosinofila: una nuova frontiera?
Dupilumab in the treatment of Eosinophilic Oesophagitis
Martina Mainetti1, Angela Troisi1, Giuliana Turlà1, Simone Fontijn1, Giovanna Rametta2, Andrea Buzzi3, Alessandro Mussetto3, Federico Marchetti1
1UOC Pediatria e Neonatologia, Ospedale di Ravenna, AUSL della Romagna
2Servizio di Farmacia Ospedaliera, Ospedale di Ravenna, AUSL della Romagna
3UOC di Gastroenterologia e Endoscopia Digestiva, Ospedale di Ravenna, AUSL della Romagna
Novembre 2022 - pagg. 583 -587 | DOI: 10.53126/MEB41583
Abstract
Eosinophilic oesophagitis (EoE) is a chronic, immune-mediated or antigen-mediated oe-sophageal disease. Therapeutic first-line options currently available for EoE are elimina-tion diets, proton pump inhibitors (PPIs) and steroids. The ultimate goal of the therapy is to avoid irreversible stricturing disease. Despite the rising prevalence of EoE, there has been little therapeutic advancement until recently. Dupilumab is one of the potential disease-modifying biologics used in various stages of clinical trials. The paper describes the case of a 10-year-old boy presenting with sub-oesophageal stricture in eosinophilic oesophagitis and steroid-dependence for disease control who was successfully treated with dupilumab.
Riassunto
L'esofagite eosinofila (EoE) è una malattia esofagea cronica, immuno-mediata o antigene-mediata. Le opzioni terapeutiche di prima linea attualmente disponibili per l'EoE sono le diete di eliminazione, gli inibitori della pompa protonica (PPI) e gli steroidi. L'obiettivo finale della terapia è quello di evitare la stenosi irreversibile della malattia. Nonostante la crescente prevalenza di EoE, fino a poco tempo fa c'è stato poco progresso terapeutico. Dupilumab è uno dei potenziali farmaci biologici modificanti la malattia utilizzati in varie fasi degli studi clinici. L'articolo descrive il caso di un bambino di 10 anni che presentava stenosi sub-esofagea nell'esofagite eosinofila e dipendenza da steroidi per il controllo della malattia, che è stato trattato con successo con dupilumab.
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Bibliografia
1. Bua J, Marchetti F, Giuseppin I, Marani M, Villanacci V, Barbi E, Martelossi S, Ven-tura A. L’esofagite eosinofila. Medico e Bambino 2007;8:500-8.
2. Lucendo AJ, Molina-Infante J, Arias Á, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017;5(3):335-358. doi: 10.1177/ 2050640616689525.
3. Dellon ES, Liacouras CA, Molina-Infante J, et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: proceedings of the AGREE conference. Gastroenterology 2018;155:1022-33. doi: 10. 1053/j.gastro.2018.07.009.
4. Munoz-Persy M, Lucendo AJ. Treatment of eosinophilic esophagitis in the pediatric patient: an evidence-based approach. Eur J Pediatr 2018;177(5):649-663. doi: 10.1007/ s00431-018-3129-7.
5. Hirano I, Chan ES, Rank MA, et al; Joint Task Force on Allergy-Immunology Practice Parameters. AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of Eosinophilic Esopha-gitis. Gastroenterology 2020;158(6):1776-86. doi: 10.1053/j. gastro.2020.02.038.
6. Cianferoni A, Spergel J. Eosinophilic Esophagitis: A Comprehensive Review. Clin Rev Allergy Immunol. 2016;50(2):159-74. doi: 10.1007/s12016-015-8501-z.
7. Arias Á, Lucendo AJ. Molecular basis and cellular mechanisms of eosinophilic eso-phagitis for the clinical practice. Expert Rev Gastroenterol Hepatol 2019;13(2):99-117. doi: 10.1080/17474124.2019.1546120.
8. Dellon ES, Spergel JM. Biologics in eosinophilic gastrointestinal diseases. Ann Al-lergy Asthma Immunol. 2022 Jun 20:S1081-1206(22)00536-1. doi: 10.1016/j.anai.2022.06. 015.
9. Hani Harb, Talal Chatila. Mechanisms of Dupilumab. Clin Exp Allergy 2020;50(1):5-14. doi: 10.1111/cea.13491.
10. Davis BP, Stucke EM, Khorki ME, et al. Eosinophilic esophagitis-linked calpain 14 is an IL13-induced protease that mediates esophageal epithelial barrier impairment. JCI Insigth 2016;1(4):e86355. doi: 10.1172/jci.insight.86355.
11. Sastre J, Davila I. Dupilumab: A New Paradigm for the Treatment of Allergic Disease. J Investig Allergol Clin Immunol 2018;28 (3):139-150. doi: 10.18176/jiaci.0254.
12. Licari A, Castagnoli R, Marseglia A, et al. Dupilumab to Treat Type 2 Inflammatory Diseases in Children and Adolescents. Paediatr Drugs 2020;22(3):295-310. doi: 10.1007/ s40272-020-00387-2.
13. Munoz-Bellido FJ, Moreno E, Davila I. Dupilumab: A Review of Present Indications and Off-Label Use. J Investig Allergol Clin Immunol 2022;32(2):97-115. doi: 10.18176/ jiaci.0682.
14. Beck LA, Thaçi D, Hamilton JD, et al. Dupilumab treatment in adults with moderate-to-severe atopic dermatitis. N Engl J Med 2014;371:130-9. doi: 10.1056/NEJMoa 1314768.
15. Tsianakas A, Luger TA, Radin A. Dupilumab treatment improves quality of life in adult patients with moderate-to-severe atopic dermatitis: results from a randomized, placebo-controlled clinical trial. Br J Dermatol 2018;178(2):406-14. doi: 10.1111/bjd.15905.
16. Simpson EL, Bieber T, Guttman-Yassky E, et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. N Engl J Med 2016:375:2335-48. doi: 10.1056/NEJMoa1610020.
17. Wenzel S, Castro M, Corren J, et al. Dupilumab efficacy and safety in adult with uncontrolled persistent asthma despite e medium-to-high-dose inhaled corticosteroids plus a long-acting beta2 agonist: a randomised double-blind placebo-controlled pivotal phase 2b dose-ranging trial. Lancet 2016; 388:31-44. doi: 10.1016/S0140-6736(16)30307-5.
18. Bacharier LB, Maspero JF, Katelaris CH, et al. Liberty Asthma VOYAGE Investiga-tors. Dupilumab in Children with Uncontrolled Moderate-to-Severe Asthma. N Engl J Med 2021;385(24):2230-40. doi: 10.1056/NEJMoa2106567.
19. Bachert C, Mannent L, Naclerio RM, et al. Effect of Subcutaneous Dupilumab on Nasal Polyp Bur-den in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial. JAMA. 2016;315:469-79. doi: 10.1001/jama.2015.19330.
20. Dupixent - INN Dupilumab - European Medicines Agency - https://www.ema.europa.eu/en/documents/product-information/ dupixent-epar-product-information_it.pdf.
21. Hirano I, Dellon ES, Hamilton JD, et al. Efficacy of Dupilumab in a Phase 2 Rando-mized Trial of Adults With Active Eosinophilic Esophagitis. Gastroenterology 2020;158 (1):111-122.e10. doi: 10.1053/j.gastro.2019. 09.042.
22. FDA Approves First Treatment for Eosinophilic Esophagitis, a Chronic Immune Di-sorder. Available online: https://www.fda. gov/news-events/press-announcements/ fda-approves-first-treatment-eosinophilic-esophagitis-chronic-immune-disorder (accessed on 21 May 2022).
23. Al-Horani RA, Chiles R. First Therapeutic Approval for Eosinophilic Esophagitis. Gastroenterol Insights 2022;13(3):238-244. doi: 10.3390/gastroent13030024.
24. Spergel BL, Ruffner, MA, Godwin BC. Improvement in eosinophilic esophagitis when using dupilumab for other indications or compassionate use. Ann Allergy Asthma Immunol 2022;128:589-93. doi: 10.1016/j. anai.2022.01.019.
Corrispondenza: martina.mainetti@auslromagna.it