Effect of benralizumab on histopathology and inflammatory signatures in a clinical cohort of eosinophilic esophagitis

• Published in: Diseases of the esophagus 2025-01, Vol.38 (1)
• Main Authors: Pyne, Ashley L, Uchida, Amiko M, Hazel, Mark W, Stubben, Chris J, Chang, Joy W, Bailey, Dominique D, Gonsalves, Nirmala, Allen-Brady, Kristina, Peterson, Kathryn A, Pletneva, Maria A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Antibodies, Monoclonal, Humanized - pharmacology; Antibodies, Monoclonal, Humanized - therapeutic use; Eosinophilic Esophagitis - drug therapy; Eosinophilic Esophagitis - pathology; Eosinophils - drug effects; Esophagoscopy; Esophagus - drug effects; Esophagus - pathology; Female; Humans; Interleukin-5 Receptor alpha Subunit - genetics; Male; Middle Aged; Retrospective Studies; Special Collection: Eosinophilic esophagitis; Treatment Outcome; Young Adult
• ISSN: 1120-8694; 1442-2050; 1442-2050
• DOI: 10.1093/dote/doae031

A preliminary report from the recent phase 3 trial of benralizumab, a monoclonal antibody that binds to interleukin-5 receptor alpha (IL5Rα), in patients with EoE revealed that medication use led to tissue eosinophil eradication but did not meet the clinical endpoint of symptom resolution. Here, we characterized the clinical, endoscopic, histologic, and transcriptional changes in patients with active EoE following benralizumab treatment. We retrospectively examined patients with EoE treated with benralizumab at the University of Utah (n = 11) and reviewed reported clinical symptoms, circulating and tissue eosinophilia, and endoscopic and histologic scores. Gene expression profiles from available esophageal tissue from benralizumab-treated patients were compared to those from patients with remission EoE (n = 5), active EoE (n = 10), and controls (n = 22). Benralizumab treatment resulted in partial symptom improvement and significant reduction in tissue eosinophilia, and endoscopic and histologic disease scoring (P