A Pilot Study of the Treatment of Eosinophilic Esophagitis With Omalizumab

Eosinophilic esophagitis (EE) is an increasingly recognized condition characterized by dysphagia, food impaction or other obstructive esophageal symptoms in children and young adults.

The pathophysiology of EE appears to be an allergy/atopy mediated disease. A personal and family history of allergic diseases (food allergies, atopic dermatitis, asthma, allergic rhinitis or conjunctivitis) has been noted in 62-85% of patients with EE. The rising incidence of EE may be related to the worldwide allergy and asthma epidemic.

Current treatment of EE is directed at decreasing esophageal allergic inflammation. Oral and topical corticosteroids, cromolyn sodium, montelukast and elemental/elimination diets have all been shown to be effective. However, none of these treatments are directed at the specific pathophysiologic mechanism of EE and some have significant side effects.

The shared pathogenetic mechanisms of EE and asthma suggest that therapeutic strategies directed at asthma may also be effective for EE. Specifically those targeted at the allergic immune mechanisms involved with asthma may be effective. Omalizumab is a recently developed anti-IgE antibody that has been shown to decrease the use of inhaled and oral corticosteroids, reduce the frequency of asthma exacerbations, and improve asthma related symptoms in patients with allergic asthma. The objective of the study is to determine the efficacy of omalizumab in the treatment of eosinophilic esophagitis

Study Overview

• Status: Completed
• Conditions: Esophagitis
• Intervention / Treatment: Drug: Placebo; Drug: omalizumab

Detailed Description

This is a dual-center double-blind, placebo controlled trial of omalizumab for the treatment of EE. Omalizumab will be dosed depending on the patient's body weight and baseline IgE level. Omalizumab or placebo will be administered subcutaneously every 4 weeks for 16 weeks. At study entry subjects will have EGD with biopsies performed to ensure the diagnosis and obtain tissue for histologic analysis. No dilation will be performed at this time. Baseline validated questionnaires for dysphagia, GERD, and atopy will also be administered. Blood will be drawn for baseline serum testing. Repeat questionnaires and rating of overall symptom improvement will be administered at 4 week intervals for the rest of the study period. At the end of the 16 week period, repeat endoscopy will be performed and biopsies taken. Esophageal dilation may be performed if clinically indicated at this time. Blood will also be drawn for repeat serum testing.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • Utah
    • Salt Lake City, Utah, United States, 84132
      • University of Utah HSC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 60 years (ADULT, CHILD)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Male or female subjects aged 12-60 years of age with EE as defined above
• Serum IgE level 30-700 IU/mL
• Subjects with acceptable medical history, physical exam and laboratory test results
• No history of bleeding diathesis, significant cardiopulmonary disease, or other contraindication to upper endoscopy

Exclusion Criteria:

• Need for esophageal dilation at enrollment due to food impaction or inability to pass endoscope
• Inability of subject to provide informed consent (if ages 18-60), or inability of children (ages 12-17) to provide assent
• History of esophagogastric surgery
• Presence of other esophageal pathology that could account for patients' symptoms including eosinophil infiltration due to gastroesophageal reflux disease (GERD)
• Incarceration
• Pregnancy
• Women of childbearing potential not using the contraception method(s)
• Patients with elevated serum IgE levels for reasons other than atopy
• Patients taking cromolyn sodium or nedocromil sodium within 1 month of visit 1
• Patients taking oral or topical corticosteroids within one month of visit 1
• Patients taking leukotriene receptor inhibitors within one month of visit 1
• Patients with severe medical condition(s) that in the view of the investigator prohibits participation in the study
• Patients with a history of noncompliance to medical regimens or who were considered potentially unreliable
• Use of any other investigational agent in the last 30 days
• Patients with a known hypersensitivity to any ingredient of rhuMAb-E25, study rescue medication
• Patients with Barrett's esophagus will be excluded if found endoscopically or pathologically at biopsy
• Currently treated with omalizumab or treated with omalizumab within the past 6 months.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: TREATMENT
• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: TRIPLE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
PLACEBO_COMPARATOR: placebo; placebo group	Drug: Placebo; Placebo given IV once every 2-4 weeks based on weight; Other Names: saline
EXPERIMENTAL: omalizumab; Xolair group	Drug: omalizumab; omalizumab dosed IV based on IgE level and weight every 2 - 4 weeks; Other Names: Xolair

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Change in Eosinophil Numbers Per High Power Field Proximally and Distally Between Baseline and Post-treatment and Between Both Groups	16 weeks

Collaborators and Investigators

• Sponsor: University of Utah
• Collaborators: Novartis Pharmaceuticals

Publications and helpful links

General Publications

• Clayton F, Fang JC, Gleich GJ, Lucendo AJ, Olalla JM, Vinson LA, Lowichik A, Chen X, Emerson L, Cox K, O'Gorman MA, Peterson KA. Eosinophilic esophagitis in adults is associated with IgG4 and not mediated by IgE. Gastroenterology. 2014 Sep;147(3):602-9. doi: 10.1053/j.gastro.2014.05.036. Epub 2014 Jun 4.

Study record dates

Study Major Dates

• Study Start: November 1, 2005
• Primary Completion (ACTUAL): January 1, 2010
• Study Completion (ACTUAL): January 1, 2010

Study Registration Dates

• First Submitted: July 21, 2005
• First Submitted That Met QC Criteria: July 21, 2005
• First Posted (ESTIMATE): July 25, 2005

Study Record Updates

• Last Update Posted (ESTIMATE): May 20, 2016
• Last Update Submitted That Met QC Criteria: May 18, 2016
• Last Verified: March 1, 2016

More Information

Terms related to this study

• Keywords: omalizumab; eosinophilic esophagitis
• Additional Relevant MeSH Terms: Digestive System Diseases; Immune System Diseases; Hypersensitivity, Immediate; Hematologic Diseases; Gastrointestinal Diseases; Gastroenteritis; Hypersensitivity; Esophageal Diseases; Leukocyte Disorders; Eosinophilia; Eosinophilic Esophagitis; Esophagitis; Anti-Asthmatic Agents; Respiratory System Agents; Anti-Allergic Agents; Omalizumab
• Other Study ID Numbers: 13623