Biologics for eosinophilic esophagitis: Past, present, and future

Eosinophilic esophagitis is a chronic allergen-mediated disease of the esophagus, characterized by eosinophilic infiltrate and esophageal dysfunction. The historical mainstays of treatment have included specific food elimination diets, topical steroids, and proton-pump inhibitors. However, despite treatment with multiple therapies, many patients remain symptomatic and with sustained esophageal eosinophilia, which lead to progressive fibrosis and dysphagia. Given the efficacy surrounding targeted biologic therapies for other allergic conditions, the development of effective and targeted treatments for eosinophilic esophagitis has been an ongoing focus in research and drug development. To date, several biologic monoclonal antibody therapies have been investigated for efficacy and safety as potential therapies for eosinophilic esophagitis. Currently, dupilumab remains the only biologic approved for use in children and adults with eosinophilic esophagitis, however, other potential agents remain under investigation, including some in late-phase trials with promising preliminary outcomes. In this review, I aim to present an overview of the historical and current study of biologic agents for the treatment of eosinophilic esophagitis.