Study Finds Most Effective Therapies for Symptomatic Improvement in Eosinophilic Esophagitis
USA: Researchers have found in a new systematic review and network meta-analysis that only Dupilumab, Cendakimab, and Budesonide demonstrated significant symptomatic improvement in eosinophilic esophagitis. The research has been published in Clinical Gastroenterology and Hepatology by Mohammad Al Hayek from the Faculty of Medicine, Damascus University, and colleagues.
Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition characterized by esophageal inflammation and symptoms such as dysphagia. While multiple pharmacological therapies are available, their relative effectiveness has remained unclear, with no established treatment hierarchy. To address this gap, the researchers conducted a comprehensive network meta-analysis comparing commonly used therapies, including corticosteroids, biologics, and proton pump inhibitors.
For this purpose, randomized controlled trials of at least 12 weeks’ duration were identified from major databases, including PubMed, Scopus, Web of Science, and the Cochrane Library. The analysis focused on adolescent and adult patients aged 12 years and older. Key outcomes included improvement in swallowing difficulty and histological remission, defined by reduced eosinophil counts in esophageal tissue, assessed at 12, 24, and 48 weeks.
The following were the key findings:
- A total of 13 randomized controlled trials were included in the analysis.
- Dupilumab and cendakimab showed consistent improvement in dysphagia at both 12 and 24 weeks.
- Budesonide oral suspension demonstrated significant benefit at 12 weeks.
- Long-term data for budesonide oral suspension were limited.
- Budesonide orodispersible tablets were the most effective option for sustained symptom relief at 48 weeks.
- Ranking analysis showed dupilumab had the highest probability of effectiveness for short- to mid-term symptom improvement.
- Budesonide formulations performed strongly for long-term outcomes.
- Both biologics and corticosteroids play an important role in managing EoE symptoms.
- Most therapies, except etrasimod, were associated with reductions in esophageal eosinophil counts.
- Histological improvement did not always correspond with symptom relief.
- Achieving tissue-level remission may not necessarily lead to better patient-reported outcomes.
The authors also pointed out important limitations in the existing evidence base. Many corticosteroid studies were short in duration and lacked direct comparisons with biologic agents. Additionally, variability in study designs and endpoints makes it challenging to establish definitive treatment pathways.
Overall, the findings suggest that while several therapies can effectively reduce inflammation in EoE, only a select few—namely dupilumab, cendakimab, and budesonide—consistently improve symptoms experienced by patients. The study underscores the need for well-designed head-to-head trials to better define optimal treatment strategies, evaluate long-term efficacy, and guide clinical decision-making in eosinophilic esophagitis.
Reference:
Al Hayek, M., Lucendo, A. J., Savarino, E. V., Barberio, B., Gyawali, C. P., Chan, W. W., Visaggi, P., Najah, Q., Yadlapati, R., McCoul, E. D., Elhadi, M., & Laine, L. (2026). Efficacy of Biological and Steroid Therapies in Adolescent and Adult Patients with Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis with Meta-regression. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2026.04.003
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