Phase 2 Findings Highlight Promise and Unanswered Questions about EoG Treatment
A Phase 2 trial of dupilumab in eosinophilic gastritis (EoG) significantly reduced gastric eosinophilic inflammation and improved histologic and endoscopic measures—adding evidence that type 2 inflammation may be an important therapeutic target in a disease with no approved treatments.
But the study also highlights an important question for gastroenterologists: How do improvements at the histologic or endoscopic level translate into meaningful symptom improvement?
For clinicians, that distinction is important when considering what the findings do—and do not—mean for the future treatment of EoG.
Phase 2 Findings Strengthen the Case for Targeting Type 2 Inflammation
The multicenter Dupilumab Eosinophilic Gastritis Study (DEGAS) evaluated dupilumab, a monoclonal antibody that blocks signaling from interleukin-4 and interleukin-13, key drivers of type 2 inflammation.
The study included 41 patients ages 12 to 59 with active EoG. After 12 weeks, patients receiving dupilumab had a 50% estimated mean reduction in gastric eosinophil counts compared with a 4% reduction among patients receiving placebo. Significant differences favoring dupilumab were also observed in other histologic and endoscopic measures.
The findings provide preliminary proof-of-concept evidence that targeting type 2 inflammatory signaling can reduce eosinophilic inflammation in EoG, supporting further, larger trials of targeted approaches to better understand if this approach can be clinically useful to patients.
Read the full DEGAS study for additional findings and methodology.
The Disconnect Between Tissue Response and Symptoms Is a Key Question
The findings do not establish whether dupilumab is a successful treatment for EoG. Instead, they highlight the need for future EoG studies to examine the relationship between improvements seen on biopsy and endoscopy and the symptoms patients experience, as well as the potential and need for further study of IL-4 / IL-13 blockade as a clinically useful treatment for EoG.
Although DEGAS demonstrated improvements in gastric eosinophil counts, histology and endoscopic findings, symptom scores did not significantly differ from placebo at 12 weeks.
Larger studies will be needed to further evaluate symptom response and longer-term effects, as well as questions surrounding treatment duration and dosing.
