Dupilumab for Eosinophilic Esophagitis With Severe Strictures

Sponsored by University of North Carolina, Chapel Hill

About this trial

Last updated 5 months ago

Study ID

23-2625

Status

Enrolling by invitation

Type

Interventional

Phase

Phase 4

Placebo

Accepting

16+ Years

All Sexes

Trial Timing

Started 2 years ago

What is this trial about?

The purpose of this research study is to determine how well an FDA-approved drug, dupilumab, works to treat patients with severe strictures and active Eosinophilic Esophagitis (EoE). This is an open-label study, meaning everyone in the study will receive dupilumab. Participants will have a screening visit where they will complete surveys and undergo an endoscopy (EGD). Blood and biopsies (small tissue samples) will also be collected. If eligible and enrolled into the study, participants will receive weekly subcutaneous (under the skin) injections of dupilumab for 52 weeks (one year). The first dose of dupilumab will be administered in the clinic at the enrollment visit (day 0) and participants (or their caregivers) will receive training on how to self-administer the remaining doses. Participants will return for study visits every at weeks 4, 8, 12, 18, 24, 30, 36, 44, and 52. During these visits, vital signs (temperature, heart rate, etc.) will be collected and participants will complete surveys. During visits at week 12, 24, and 52, blood will be collected and an endoscopy with biopsy will be performed. At 64 weeks (12 weeks after the last dose of dupilumab), participants assigned female at birth (AFAB) may be asked to come to the clinic for a urine pregnancy test.

What are the Participation Requirements?

Requirements to be eligible for the study: 1. Age 16 and older. 2. Diagnosis of EoE (per 2018 AGREE consensus guidelines). 3. Currently active EoE (defined as ≥15 eos/hpf [eosinophils per high power field]) based on samples taken from the screening endoscopy. 4. Prior intolerance to or histologic non-response (defined as a peak esophageal eosinophil count of ≥15 eos/hpf) to proton pump inhibitors (PPI) and topical corticosteroids (tCS). * For PPI, this must be after 8 weeks or more of treatment of at least 40mg daily of any of the approved medications. * For tCS, this must be after 8 weeks or more of treatment of at least 2mg daily for budesonide or 1760 mcg daily for fluticasone). 5. One of the following specific EoE features: * A narrow esophagus (previous endoscopy with a severe, <10mm area of narrowing or where a standard adult endoscope would not fit), OR * 4 or more prior esophageal dilations (stretching procedures) with at least 2 dilations occurring within one year. 6. Willing to follow certain lifestyle considerations during the study including: * No diet changes, * No changes in PPI medication (such as omeprazole [Prilosec], esomeprazole [Nexium], lansoprazole [Prevacid], etc) dose, * No topical/swallowed (such as flucticasone [Flovent], budesonide [Eohilia], etc) or systemic steroids (such as prednisone) for add-on EoE therapy, * Use highly effective birth control methods (for people assigned female at birth who are able to get pregnant). 7. Weigh at least 40kg (about 89 pounds or more). Reasons a participant could be excluded: 1. Other eosinophilic gastrointestinal (GI) disease including: * Eosinophilic gastritis, * Eosinophilic enteritis, * Eosinophilic colitis, * Hypereosinophilic syndrome. 2. Recent steroid use (systemic or swallowed/topical corticosteroid within 4 weeks prior to the screening endoscopy). 3. Recent use of dupilumab (Dupixent) (within about 5 months of screening) or prior allergic reaction to dupilumab or its components, or dupilumab intolerance. 4. Recent use of other biologic medications (within either 5 months or 5 half-lives, whichever is longer). Examples of biologic medications include: * mepolizumab (Nucala), * reslizumab (Cinqair, Cinqaero), * benralizumab (Fasenra), * cendakimab, * tezepelumab (Tezspire), * barzolvolimab, etc. 5. Prior esophageal resection (surgery to remove the esophagus). 6. Participants taking blood thinners (such as coumadin, warfarin, heparin, etc.) who are unable to stop taking them for a brief period prior to EGD (as required by normal clinical practice). 7. Recent vaccination with a live (attenuated) vaccine (within 4 weeks of screening). Live vaccines include: * Chickenpox (varicella), * FluMist and Intranasal influenza, * Measles (rubeola), * Mumps, * Rubella, * Oral polio, * Oral typhoid, * Smallpox (vaccinia), * Yellow fever, * Bacille Calmette-Guerin * Rotavirus * Combination vaccines of any of the above. 8. Study doctor's determination that it would not be medically safe to complete an EGD. 9. Inability to read or understand English. 10. Currently pregnant or breastfeeding. 11. Currently in screening or eligible for another study of dupilumab (Dupixent).