Dupilumab is not only the first biologic drug for EoE, but also the first drug of any class to be approved to treat the condition — an immune system disorder in which exposure to an allergen causes inflammation and swelling in the lining of the esophagus.
With one biologic in the EoE arsenal, several others may be on the way. If you’re living with EoE and not happy with your current treatment, it may be worth talking to your doctor about trying a biologic. To make that conversation as productive as possible, it can help to first learn all you can about biologics and how they help treat EoE.
How Biologics Treat EoE
5 Essential Facts About Biologics for Eosinophilic Esophagitis
1. The U. S. Food and Drug Administration (FDA) has approved only one biologic to treat eosinophilic esophagitis (EoE).
That drug, dupilumab, is sold under the brand name Dupixent. It is approved to treat EoE in adults and children older than 12.
2. Other biologics are being studied for the treatment of EoE.
In time, dupilumab may no longer stand alone for EoE, as there are several other biologics in the works, says Brooks Cash, MD, a gastroenterologist with University of Texas Health in Houston.
They include antolimab (Allakos), benralizumab (Fasenra), and RPC4046 , which are in various stages of development, according to a review published in June 2020.
3. Biologics are injectable medications.
Some biologics are given intravenously (through a needle into a vein) and some by infusion at a clinic or other setting. The biologic approved for EoE is self-administered subcutaneously, into the layer of fat just beneath the surface of the skin. You give it to yourself using an injector pen that comes prefilled with the prescribed dose of medication, typically 300 milligrams.
4. Taking a biologic for EoE may help treat associated conditions.
Biologic drugs are approved to treat a wide range of chronic disorders, says Jonathan Spergel, MD, PhD, chief of the allergy program at Children’s Hospital of Philadelphia. Dupilumab in particular is approved to treat other conditions caused by the overzealous release of cytokines by the immune system, including atopic dermatitis (a type of eczema), asthma, and chronic rhinosinusitis.
What’s more, research shows most people who have EoE also have one or more other immune system disorders, so taking a biologic for EoE may help relieve them as well, says Dr. Cash.
Incidentally, the reverse may be true, too. In a study published in May 2022 in Annals of Allergy, Asthma & Immunology, kids treated with dupilumab for atopic dermatitis, asthma, or nasal polyps also experienced improvements in their EoE symptoms.
5. Biologics are considered safe but may cause some minor side effects.
Biologics, unlike conventional medications, are created using living cells rather than biochemicals and have a solid safety track record. They’ve been available in the United States for decades, and most people who take them have no serious problems, says Cash.
Even so, no medication is without side effects. In people with EoE who take dupilumab, for example, the most common side effects include upper respiratory tract infections, cold sores, joint pain, and reactions around the injection site, such as soreness, itching, and redness.
When Is It Time to Try a Biologic for Eosinophilic Esophagitis?
There are no established guidelines for when a biologic like dupilumab should be prescribed for eosinophilic esophagitis (EoE), but it’s usually reserved for when first-line treatments aren’t working. In the case of EoE, these are typically proton pump inhibitors (PPIs) and corticosteroids, both prescribed for off-label use for EoE.
Along with medication, EoE sometimes is managed with an elimination diet, which involves removing common food allergens — typically, dairy, eggs, soy, and wheat — from the diet and then adding them back in one at a time to determine which, if any, trigger symptoms and should be avoided.
“We have years of experience [treating eosinophilic esophagitis] with those therapies, and we know they can work,” says Cash. “Just because [dupilumab] is the only FDA-approved therapy doesn’t mean that it moves straight to the top of the line.”
That said, if you have another allergic condition, such as asthma or atopic dermatitis, you may be a good candidate for dupilumab, says Cash, since it blocks IL-4 and IL-13, the cytokines that play a role in triggering allergic reactions.
6 FAQs About Taking a Biologic for Eosinophilic Esophagitis
Making the Decision to Take a Biologic for Eosinophilic Esophagitis
You’ve learned how biologics work and how they treat EoE. Next step: Figure out if this type of drug might be right for you.
Before your next doctor’s appointment, ask yourself these key questions:
- Are you satisfied with your current treatment?
- Has it improved your symptoms as much as you’d hoped?
- If you follow an elimination diet, are you satisfied with it?
- How would you rate your quality of life? For example, does EoE cause you to feel anxious or depressed? Does it interfere with your daily routine?
If you’ve recently been diagnosed with eosinophilic esophagitis or aren’t satisfied with your current treatment, you may want to consider taking a biologic. Here are a few questions you can bring with you to your next doctor’s appointment. Use them to help you guide the conversation and learn whether this medication may be right for you.
- Am I a good candidate for a biologic?
- What can I expect by taking this medication?
- How long will the medication take to work?
- What type of symptom relief can I expect?
- How long will I need to take a biologic?
- Are there any medications, supplements, or preexisting conditions that can interfere with this treatment?
- What else should I know before I try a biologic?