Comparing Eosinophilic Esophagitis Treatments for Patients with Severe Disease

Pediatric gastroenterologist Calies Menard-Katcher, MD, MSCS, has received an R01 grant from the National Institutes of Health (NIH) to support her research on eosinophilic esophagitis (EoE), specifically comparing treatments for those with severe cases.

Her journey to studying EoE began over a decade ago as a medical fellow. The condition, which is characterized by the swelling of the esophagus triggered by food allergies, continues to present new challenges. As Dr. Menard-Katcher dives deeper, the more it seems there is to uncover.

“There are many more questions than answers,” Dr. Menard-Katcher explains. “We’re just beginning to chip away.”

Dr. Menard-Katcher's newest project compares existing FDA approved therapies for EoE for their ability to treat fibrostenotic EoE, a more severe form of the disease.

In EoE, eosinophils — white blood cells involved in allergic responses — build up in the esophagus. They often inflame and injure esophageal tissue. For those with fibrostenotic EoE, this inflammation leads to stricture, or a narrowing of the esophagus and problems with swallowing.

This study examines the EoE treatments dupilumab and fluticasone. Dupilumab is an injectable biologic. It works by blocking interleukin-4 (IL-4) and interluekin-13 (IL-13), which are key proteins that drive eosinophil inflammation. Fluticasone is a swallowed topical corticosteroid. It helps reduce the swelling in the esophageal lining.

This is the first comparative randomized trial of EoE treatments, and it’s the first clinical trial specifically examining patients with stricture. The 16-week study aims to enroll 36 patients with fibrostenotic EoE. Using histology and distensibility, they’ll evaluate which treatment is better at treating inflammation or even reversing the narrowing of the esophagus. The goal is to provide better treatment guidance to patients and families.

“We’re focusing on answering who, what and when we should be using particular therapies. These questions often come from clinicians and patients, and the answers have the chance to directly impact clinical care,” Dr. Menard Katcher says. “So, it’s really exciting to be able to do an investigator-initiated trial to start to answer these questions.”

Dr. Menard-Katcher says the infrastructure and expertise at Children's Colorado, the Colorado Child Health Research Institute and the University of Colorado Anschutz Medical Campus were integral to getting the study started.

“I'm really excited for my patients and what we might uncover. The groundwork for this study will lead to others,” Dr. Menard-Katcher says.