EoE (eosinophilic esophagitis) is a chronic, immune-mediated condition characterized by mucosal inflammation and esophageal dysfunction as the result of an eosinophilic-predominant immunogenic reaction. EoE, with onset typically secondary to genetic predisposition or antigen-triggered in etiology, results in damage to the esophagus that symptomatically can present as dysphagia, odynophagia, episodes of choking episodes, or can be asymptomatic for some patients. With an NIH-estimated 160,000+ individuals impacted by this chronic condition, it is important to take into account the significant impacts EoE can have for patients in terms of both physical challenges and emotional well-being.

Surprisingly, there are not many US-based guidelines that address management and treatment of EoE, but in this article we will be examining the most recent guidelines on Eosinophilic Esophagitis (EoE). Published in April of 2020, the most recent guideline was published by the American Gastroenterological Association (AGA) and the Joint Task Force on Allergy Immunology Practice Parameters (JTF), a multi-disciplinary coalition that includes the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology. Since these guidelines were published in 2020, there have been two new medications approved (Eohilia & Dupixant) in the treatment of Eosinophilic Esophagitis. This article will take a look at what has changed since the guideline’s publication, and what the next Clinical Practice Guidelines for EoE may look like as a result of these more recent FDA medication approvals.

Part 1 – Current EoE Guidelines

To start, here is a listing of the current Eosinophilic Esophagitis Guidelines in the US:

Part 2 – FDA Approvals Since the Most Recent Guidelines

Eohilia (budesonide oral suspension)

  • Takeda Pharmaceuticals
  • FDA Approved February 2024
  • EOHILIA is an oral corticosteroid now indicated to treat EoE for 12 weeks in individuals 11 years of age and older. Clinical studies have demonstrated its effectiveness in reducing esophageal inflammation and enhancing swallowing function.

Dupixent (dupilumab)

  • Sanofi / Regeneron
  • FDA Approved May 2022
  • Dupixent is an Il-3/IL-4 targeting monoclonal antibody now indicated for individuals 1 year of age or older, weighing at least 15kg, to help reduce and prevent EoE-related inflammation and esophageal damage.

Part 3 – Predictions

Now that we’ve covered the current available EoE guidelines, the “what’s changed” and new FDA approvals since the most recent 2020 publication, we can jump into the predictions. As a reminder, this is a list of predictions focused specifically on treatment of EoE, and including pharmacological treatments. These predictions are not based on specific guidelines or a specific organization, but instead provide broad, high-level predictions covering potential next guideline(s) on the topic of EoE, regardless of which organization produces them.

Prediction 1

  • As our understanding of EoE continues to evolve, there is a recognition of the multifactorial underlying etiologies and patient-specific risk factors that contribute to the development and persistence of this condition. Future guidelines are likely to highlight the importance of personalized treatment approaches, taking into account factors such as disease severity, phenotype, and individual patient characteristics. This shift towards personalized care has the potential to revolutionize the management of EoE, allowing for more tailored strategies that may include targeted therapies, adjunct treatments, and customized dietary plans.

Prediction 2

  • There will be a new recommendation inclusion and/or entirely new guideline discussing pharmacologic recommendations for the management of EoE that includes Eohilia (budesonide oral suspension) & Dupixent (dupilumab) as a potential treatment option.

Prediction 3

  • With advancements in testing used to identify potential allergen-mediated triggers that may precede or exacerbate symptoms, there is a growing emphasis on considerations regarding dietary interventions in the management of EoE. Allergists as well as registered dietitians can provide valuable assistance in developing a customized food-elimination diet that not only addresses the specific dietary needs of individuals with EoE but also ensures that their nutritional requirements are met.

Prediction 4

  • Recent research has highlighted the significance of telemedicine in improving patient care. It is anticipated that future guidelines will likely include recommendations for utilizing telemedicine, mobile health apps, and remote monitoring devices to enhance communication, increase patient engagement, and optimize care delivery for individuals with EoE.

There you have it – an overview of the current EoE guidelines, updates on recent major changes and FDA approvals have happened since publication, and our informal, but evidence-based, predictions for what the next guidelines on Eosinophilic Esophagitis may include. Once the next EoE guideline update happens, we will compare our predictions to reality to see how we measured up. Do you agree with our predictions? Do you think we missed anything? We’d love to hear your input!

Are there other topics you would like to see covered in a future guideline predictions series article? Contact us today and let us know!

Copyright © 2024 Guideline Central, all rights reserved.