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Clinical Trial
. 2006 Dec;118(6):1312-9.
doi: 10.1016/j.jaci.2006.09.007. Epub 2006 Nov 7.

Anti-IL-5 (mepolizumab) therapy for eosinophilic esophagitis

Miguel L Stein  1 , Margaret H Collins, Joyce M Villanueva, Jonathan P Kushner, Philip E Putnam, Bridget K Buckmeier, Alexandra H Filipovich, Amal H Assa'ad, Marc E Rothenberg
Affiliations
Clinical Trial

Anti-IL-5 (mepolizumab) therapy for eosinophilic esophagitis

Miguel L Stein et al. J Allergy Clin Immunol. 2006 Dec.

Abstract

Background: Eosinophilic esophagitis (EE) is characterized by high numbers of eosinophils in the esophagus and epithelial hyperplasia, and is being increasingly recognized. IL-5 promotes eosinophil trafficking to the esophagus, and positively regulates eosinophil growth, activation, survival, and tissue recruitment.

Objective: We hypothesized that the humanized monoclonal IgG(1) antibody against human IL-5 (mepolizumab) may be useful in the control of EE.

Methods: An open-label phase I/II safety and efficacy study of anti-IL-5 in 4 adult patients with EE and longstanding dysphagia and esophageal strictures was conducted. Patients received 3 infusions of anti-IL-5 (750 mg intravenously monthly) without change in their current therapy. The levels of plasma IL-5, peripheral blood eosinophils, and CCR3+ cells in blood, quality of life measurements, and histological analysis of esophageal biopsies were determined before and 1 month after treatment.

Results: Peripheral blood eosinophilia and percent of CCR3+ cells decreased by 6.4-fold and 7.9-fold (P < .05), respectively, after anti-IL-5 treatment. Notably, mean and maximal esophageal eosinophilia decreased from 46 to 6 and from 153 to 28 eosinophils/high-power field (x400; average, 8.9-fold, P < .001, and 6-fold, P < .05), respectively. Patients reported a better clinical outcome and improved quality of life (P = .03). Therapy was generally well tolerated, and responsiveness to anti-IL-5 therapy did not correlate with plasma IL-5 levels.

Conclusion: Anti-IL-5 therapy is associated with marked decreases in peripheral blood and esophageal eosinophilia (including the number of CCR3+ blood cells) in patients with EE and improved clinical outcomes.

Clinical implications: Anti-IL-5 is a promising therapeutic intervention for EE.

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Comment in

  • Biologicals move into the esophagus.
    Croft NM. Croft NM. Gastroenterology. 2007 Jul;133(1):358-60; discussion 360. doi: 10.1053/j.gastro.2007.05.034. Gastroenterology. 2007. PMID: 17631160 No abstract available.

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