The ulcerative colitis drug etrasimod (Velsipity, Pfizer) appears to be efficacious in eosinophilic esophagitis (EoE), with notable reductions seen in eosinophils.
Etrasimod, an investigational, oral selective sphingosine-1-phosphate (S1P)–receptor modulator, also improved endoscopic features of EoE, overall symptom severity, and dysphagia in some patients, researchers reported.
“These results support further investigation of etrasimod in EoE,” said Evan S. Dellon, MD, MPH, AGAF, of the University of North Carolina at Chapel Hill.
Dr Dellon presented the results from the phase 2 study at the October 2023 2023 Annual Scientific Meeting of the American College of Gastroenterology in Vancouver, Canada.
In the VOYAGE study, 108 adults were included, with about half female and an average EoE diagnosis for nearly 5 years.
The patients were randomized to once-daily doses of etrasimod 2 mg, etrasimod 1 mg, or placebo for 24 weeks, followed by a 28-week still-ongoing extension period investigating the efficacy and safety of daily oral etrasimod 1 mg and 2 mg, compared with placebo.
After 24 weeks of treatment, there was a 52.4% reduction in peak eosinophil count (PEC) in the group of patients who were given a 2-mg daily dose of etrasimod compared to placebo, Dr Dellon said.
Among patients given a 1-mg daily dose of etrasimod, there was a 27.4% reduction in PEC.
Meanwhile, there was a 61% increase in PEC for people who were given placebo.
Etrasimod also bested placebo on secondary outcomes in the VOYAGE study, including:
- Comprehensive histologic severity and extent scores, with a change of −0.2 in both etrasimod groups (P
- Endoscopic features (EREFS), with a decline of 1.3 for the 2-mg–dose etrasimod group (P = .0303), compared with a slight decline for the placebo group. There was a decline of 1.0 in the 1-mg–dose etrasimod group, but this was not statistically significant.
Higher Dose Arm, Better Results
In the email exchange with GI & Hepatology News, Dr Dellon said this appears to be “a dose-response where the 2-mg dose is needed to see more prominent response, but the EREFS response is in the right direction with the 1-mg dose.”
The study found a statistically significant decrease in only one segment of the trial participants, those who took the 2-mg dose and had a history of dilation, as measured by the Dysphagia Symptom Questionnaire (DSQ). In that group, there was a reported decrease of 21.6 points from baseline.
“The average scores at baseline are in the low 30s. The range for DSQ (which is a composite score of daily measurements over 14 days) is from 0 to 84,” Dr Dellon wrote. “A score in the 30s over 2 weeks is quite symptomatic, so a decrease of 21.6 points is substantial.”
Dr Dellon and coauthors said etrasimod appeared to be well tolerated with a safety profile consistent with use of the drug in patients with ulcerative colitis.
In treatment-emergent adverse events, elevation of liver transaminases was reported among four of 39 patients (10.3%) in the 1-mg etrasimod group and three of the 41 patients (7.3%) in the 2-mg etrasimod group, compared with none in the placebo group.
Bilirubin elevation was reported in two patients (5.1%) in the 1-mg etrasimod group and none in the 2-mg etrasimod or placebo groups.
Prospect of Another EoE Treatment
In an interview with GI & Hepatology News, Scott Gabbard, MD, a gastroenterologist at Cleveland Clinic, said, “For so many years, there was no FDA-approved therapy [for EoE]. Now, we do have an FDA-approved therapy.”
The FDA approved the first treatment for EoE — dupilumab (Dupixent) — last year.
“It’s exciting to suddenly have the prospect of more options for patients with EoE. We can see multiple other options for our patients who sorely need therapy coming down the pipeline,” Dr Gabbard said.
“Overall, there were no serious adverse events,” Dr Gabbard said. “There was clearly a change in baseline and overall symptom scores.”
In an email exchange with GI & Hepatology News, Jennifer Horsley-Silva, MD, of the Mayo Clinic, said the VOYAGE study was important because it serves as a proof of concept that targeting S1P receptors can affect EoE.
“A limitation of the study is it was conducted in a specific group of patients with EoE: A substantial number were refractory to corticosteroids, and over half had prior esophageal dilations,” she wrote.
Pfizer sponsored the VOYAGE trial. Dr Dellon indicated no relevant financial relationships. Dr Horsley-Silva has research funding from Regeneron/Sanofi, Allakos, Celgene, and Bristol Myers Squibb and has participated in an advisory board for Sanofi Genzyme. No disclosures were included for Dr Gabbard, and no recent paper is available in PubMed for Dr Horsley-Silva.
This article originally appeared on MDedge.com, part of the Medscape Professional Network.
Source link : https://www.medscape.com/s/viewarticle/etrasimod-appears-effective-eosinophilic-esophagitis-phase-2-2024a1000211?src=rss
Publish date : 2024-01-30 09:13:27
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