An antibody against IL-5 reduces numbers of esophageal intraepithelial eosinophils in children with eosinophilic esophagitis

Amal H. Assa'ad, Sandeep K. Gupta, Margaret H. Collins, Mike Thomson, Amy T. Heath, Deborah A. Smith, Teresa L. Perschy, Cynthia H. Jurgensen, Hector G. Ortega, Seema S. Aceves

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226 Scopus citations

Abstract

Background & Aims: The role of interleukin (IL)-5 in the pathogenesis of eosinophilic esophagitis (EoE) has been established in animal models; anti-sIL-5 therapy has been reported to be effective in adults. We investigated whether IL-5 has a role in accumulation of esophageal eosinophils in children with EoE and whether therapy with mepolizumab, an antibody against IL-5, reduces the number of esophageal intraepithelial eosinophils in children with EoE. Methods: We performed an international, multicenter, double-blind, randomized, prospective study of 59 children with EoE, defined as baseline peak count of esophageal intraepithelial eosinophils of <20 in at least 1 high-power field (hpf). Patients received an infusion every 4 weeks (a total of 3 infusions) of 0.55, 2.5, or 10 mg/kg mepolizumab. No placebo group was used. Results: Baseline peak and mean esophageal intraepithelial eosinophil counts were (mean ± SE) 122.5 ± 8.78 and 39.1 ± 3.63 per hpf, respectively. Four weeks after the third infusion, peak eosinophil counts were <5 per hpf in 5 of 57 children (8.8%); we did not observe differences among groups given different doses of mepolizumab. Reduced peak and mean eosinophil counts, to <20 per hpf, were observed in 18 of 57 (31.6%) and 51 of 57 (89.5%) children, respectively. Peak and mean esophageal intraepithelial eosinophil counts decreased significantly to 40.2 ± 5.17 and 9.3 ± 1.25 per hpf, respectively (P < .0001). An analysis to evaluate predictors of response associated a higher mean baseline esophageal intraepithelial eosinophil count with a greater reduction in mean count (P < .0001). Conclusions: IL-5 is involved in the pathogenesis of EoE in children. Mepolizumab, an antibody against IL-5, reduces esophageal eosinophilic inflammation in these patients.

Original languageEnglish (US)
Pages (from-to)1593-1604
Number of pages12
JournalGastroenterology
Volume141
Issue number5
DOIs
StatePublished - Nov 2011

Keywords

  • Clinical Trial
  • Esophagus
  • Histopathology Analysis
  • Pediatric

ASJC Scopus subject areas

  • Gastroenterology

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    Assa'ad, A. H., Gupta, S. K., Collins, M. H., Thomson, M., Heath, A. T., Smith, D. A., Perschy, T. L., Jurgensen, C. H., Ortega, H. G., & Aceves, S. S. (2011). An antibody against IL-5 reduces numbers of esophageal intraepithelial eosinophils in children with eosinophilic esophagitis. Gastroenterology, 141(5), 1593-1604. https://doi.org/10.1053/j.gastro.2011.07.044