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A study found that mepolizumab therapy can improve eosinophilic esophagitis Histologic Scoring System grade when taken for 3 months.
Mepolizumab therapy for 3 months significantly improved eosinophilic esophagitis (EoE) Histologic Scoring System (HSS) grade and stage scores compared with placebo. A moderate correlation with post-treatment Endoscopic Reference Score (EREFS) was also observed.
The randomized clinical trial (NCT03656380) included patients aged 16-75 years with EoE non-responsive to proton pump inhibitors, at least 15 eosinophils per high-power field on biopsy, and dysphagia symptoms.1 Key exclusion criteria included severe structuring, recent esophageal dilation, and recent steroid use. Researchers randomly assigned participants 1:1 to receive 300 mg subcutaneous mepolizumab or placebo for 3 months. The randomization was stratified for prior topical steroid non-response. The primary endpoints were the changes in HSS grade and stage scores at 3 months.
HSS grade and stage scores assess eight histopathologic features, including eosinophil infiltration (EI), basal zone hyperplasia (BZH), eosinophil abscess (EA), eosinophil surface layering (SL), dilated intercellular spaces (DIS), surface epithelial alteration (SEA), dyskeratotic epithelial cells (DEC), and lamina propria fibrosis (LPF).
Of the 64 patients who completed the study, 31 received mepolizumab and 33 received placebo. Baseline HSS features and total scores were similar between the groups. At month 3, mepolizumab significantly lowered the total HSS grade score (1.2 ±0.4 vs 1.7 ±0.6; P<0.001) and stage score (1.1 ±0.4 vs 1.6 ±0.6; P<0.001) compared with placebo. Eosinophil-related HSS features (EI, EA, SL, SEA) improved for both grade and stage, while non-eosinophil features (BZH, DIS, DEC, LPF) did not significantly improve. HSS scores at 3 months moderately correlated with the EREFS for both grade (P<0.001) and stage (P<0.001).
In conclusion, mepolizumab therapy for 3 months led to significant improvements in histologic severity, specifically in eosinophil-dependent features, compared with placebo.
Medical writing support was provided by Federica Angius.
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