There Remains an Unmet Need for EoE Treatments That Provide Effective, Long-term Disease Control

Patients with eosinophilic esophagitis (EoE) are faced with delayed diagnosis, burdens related to symptoms, quality of life and cost, but lack targeted systemic therapies to improve long-term disease control.

While there are effective treatments for eosinophilic esophagitis (EoE), there remains a lack of long-term control in these therapies that may also improve quality of life (QoL) for patients. A review of the disease and its unmet needs was published in The American Journal of Gastroenterology.

EoE is a progressive, lifelong disease that is thought to be triggered by type 2 immune responses to food and aeroallergens. The symptoms of EoE impair QoL of patients and many adults suffer from mental distress, the authors noted.

The disease is complex and heterogenous, and the prevalence of it is increasing worldwide. There is greater understanding of the type 2 inflammation that contributes to the disease and its progression.

Current treatments include dietary restriction, proton pump inhibitors, swallowed topical corticosteroids and dilation of the esophagus.

“There is an unmet need for safe and effective treatments offering long-term histologic, endoscopic, and symptomatic disease control in a convenient dosing regimen,” the authors wrote.

In the review, the authors highlighted patient perspectives on disease burden and the unmet need for long-term treatment. They conducted two advisory board meetings and discussions with key opinion leaders, as well as a literature search.

In addition to the disease burden related to symptoms and QoL, there is an economic burden with EoE. Elimination diets that require avoiding certain foods can be expensive. In addition, healthcare resource utilization (HRU) is high in EoE.

“Contributing factors include diagnostic delays, frequent healthcare visits, increased likelihood of emergency room visits, repeated endoscopy, costly dietary modifications, and lack of approved medications leading to out-of-pocket payment for expensive, off-label medications,” the authors wrote.

The annual total HRU costs of EoE are estimated to be as much as $947 million and the median total annual cost of a single EoE case was $3,304 in 2015. The authors noted that in the year leading up to an EoE diagnosis, patients were often treated for other conditions.

The median delay in EoE diagnosis is six years. The researchers wrote that in addition to earlier diagnosis, there needs to be standardized follow-up and treat-to-target goals in EoE to better manage disease symptoms and prevent progression.

In the medical, social and emotional domains, there are unmet needs for patients with EoE. Many patients switch therapies, highlighting the need for optimal long-term management. Another unmet need is for noninvasive biomarkers of disease activity to reduce the need for endoscopy and biopsies, both of which are invasive.

Treatment adherence is a challenge because “symptom response is not a good indication of biological response in EoE,” the authors wrote. Patient and caregiver education is important but nearly half of gastroenterologists spend 10 minutes or less providing patient education during the initial visit. However, patients who are well informed are more likely to be adherent to treatments and have better disease control.

The authors reiterated the need for treatments that provide long-term comprehensive disease control.

“The cumulation of side effects and QoL impairment can be a hindrance to adherence,” they concluded. “There is an unmet need for targeted systemic therapies that can normalize the immune response to triggers, reduce chronic inflammation, and limit or prevent fibrosis, thereby reducing patient burden.”